Mark H Wilcox

..Tigecycline has the potential to be used as monotherapy for the treatment of cSSSI and cIAI...

..The review summarizes changes in the epidemiology and treatment of Clostridium difficile-associated disease...

..MLVA was far superior to PFGE for analyzing clusters of CDI both within and between institutions. Further study is needed to examine whether subtypes of C. difficile ribotype 027 affect outcome...

..This algorithm also identifies 'potential C. difficile excretors', individuals with diarrhoeal samples that contain C. difficile but without demonstrable toxin, who may be a source of transmission of C. difficile to susceptible patients...

..Marked increases in Clostridium difficile infection (CDI) incidence, driven by epidemic strain spread, is a global phenomenon...

....

..This is particular true for infections occurring in orthopaedic patients where poorly vascularised tissue, trauma or implanted prosthetic material, pose specific challenges...

..difficile infection?..

....

..Additional infection control methods must also be explored. This review discusses the challenges posed in particular by methicillin-resistant staphylococci and potential ways forward...

..Further studies are needed to confirm this potentially low selection pressure...

..Clostridium difficile diarrhoea (CDD) cases treated with intravenous immunoglobulin during a 2 year period were reviewed to determine disease severity and response to treatment...

..The aim of this study was to determine the incidence of and risk factors for community-associated Clostridium difficile infection (CDI)...

..Lack of progress in developing new antimicrobials, particularly new classes, as opposed to variants of existing agents, has contributed to the emergence of antibiotic-resistant pathogens...

....

....

..To compare the efficacy of oritavancin and vancomycin in the treatment of Clostridium difficile infection (CDI) using an in vitro human gut model...

..We compared the behaviour of Clostridium difficile PCR ribotypes 001 and 027 in a human gut model, and compared the responses to metronidazole exposure...

....

..We screened recently isolated C. difficile (2005-06) for susceptibility to metronidazole and compared results for historic isolates (1995-2001)...

..In agar incorporation methods, the impact of supplements on oritavancin MICs was tested to address oritavancin binding to surfaces...

..This may explain the widespread dissemination of epidemic strains. Our results emphasize the importance of single-room isolation as soon as possible after the onset of diarrhea to limit the dissemination of C. difficile...

..To evaluate the relative propensities of oritavancin and vancomycin to induce Clostridium difficile infection (CDI) in hamster and in vitro human gut models...

..These in vitro results suggest that all fluoroquinolones have the propensity to induce C. difficile infection, regardless of their antianaerobe activities. Resistant mutants were seen only following moxifloxacin exposure...

..We measured an alternative endpoint, the minimum biofilm inhibitory concentration (MBIC) and compared the results with MIC and MBC...

..These findings emphasize the value of enhanced fingerprinting to confirm or refute suspected CDI case clusters...

..There are few robust in vitro data of the effects of antibiotic treatment of CDI in a gut reflective setting...

..Therapeutic options in Clostridium difficile infection (CDI) are limited. We examined linezolid activity in vitro and potential therapeutic efficacy using a gut model of CDI...

..difficile may contribute to the low risk of CDI induction. Factors other than gut microflora colonization resistance may be important in preventing C. difficile spore germination, proliferation and cytotoxin production...

..difficile AP-PCR type Ia strain. Our findings emphasize the need to understand the epidemiology and virulence of clinically significant strains to determine successful control measures for C. difficile infections...

..Tolevamer reduced neither the duration nor magnitude of cytotoxin activity by C. difficile, reflecting poor efficacy observed in recent phase III clinical trials...

..To compare the effects of hospital cleaning agents and germicides on the survival of epidemic Clostridium difficile strains...

..In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled...

..We have examined the propensity of co-amoxiclav to induce CDI using a human gut model...

..Catheter-related bloodstream infection (CRBSI) causes substantial morbidity and mortality, but few randomized, controlled studies have been conducted to guide therapeutic interventions...

..All lumens of multiple-lumen central venous catheters must be sampled to ensure maximal sensitivity...

..difficile is controlled by a two-component signal transduction system rather than a multicomponent phosphorelay. The implications of these findings for C. difficile sporulation, virulence, and transmission are discussed...

..We suggest that RIF or FUS in combination with LZD may have a role in preventing the emergence of LZD resistance...

..We believe that the gut model is a promising method for studying C. difficile pathogenesis in conditions analogous to the in vivo situation...

..The ability of E. faecalis isolates to form biofilm in vitro appears to be a marker of a virulence trait that enhances the ability of isolates to cause CRBSI...

..Ramoplanin may be more effective than vancomycin at killing spores and preventing spore recrudescence. These findings suggest a potential therapeutic role for ramoplanin in CDI that requires further clinical investigation...

..We believe the gut model is a promising approach for the study of C. difficile pathogenesis reflecting in vivo events likely to occur in CDI...

..Intravenous/oral linezolid is a promising antimicrobial agent and provides the clinician with an additional treatment option, particularly among the limited therapies for resistant Gram-positive bacterial infections...

..Implications for pneumococcal vaccination are discussed...

..These results provide some evidence that use of hypochlorite for environmental cleaning may significantly reduce incidence of CDI, but emphasize the potential for confounding factors...

..This observation may permit a better understanding of the epidemiology and pathogenicity of C. difficile infection...

..difficile. In particular, improved cleaning of frequently touched sites in the immediate bed space area is required...

..Crucially, however, controlled studies of antimicrobial prescribing interventions are lacking. The evidence for the association between antimicrobial prescribing and expansion of MRSA is reviewed here...

..NVB302 is a novel type B lantibiotic under evaluation for the treatment of CDI. We compared the responses to NVB302 and vancomycin when used to treat simulated CDI in an in vitro gut model...

..perfringens AAD and S. aureus AAD, respectively. Risk factors for these AAD pathogens differed, highlighting the need to define specific control measures. There is evidence of nosocomial transmission in cases of C. perfringens AAD...

..difficile research. It is important for future study programs to carefully consider the approach to use and therefore be better placed to inform the design and interpretation of clinical studies...

..However, the relative effectiveness of prevention interventions is unclear. Initiatives to control meticillin-resistant Staphylococcus aureus have tended to ignore the benefits of altering antimicrobial prescribing...

..baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of A. baumannii in the intensive care unit setting...

..Either isolation capacity must be increased or evidence-based risk assessment must be applied to situations where demand for isolation exceeds availability. Further information is needed on the consequences of isolation failure...

..In addition, establishing the true burden of C perfringens antibiotic associated diarrhoea is important before optimum control and treatment measures can be defined...

..baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of A. baumannii in the intensive care unit setting...

..The recovery rate of C. difficile PCR ribotype 1 was statistically significantly greater than that of other strains. This observation has implications for C. difficile epidemiological studies...

..No single, simplistic route of bacterial contamination of central venous catheters was identified, but endoluminal catheter colonisation is invariably present in cases of catheter related bloodstream infection...

..difficile diarrhoea protects against recurrence, and trials are in progress to investigate immunization: a toxoid vaccine which is immunogenic and safe in healthy volunteers shows promise for the future...

..Current treatment options are antibiotic-based, which is less than ideal. Although many biotherapeutic approaches have been tried few have shown real benefit...

..CONCLUSIONS: If only one CVC lumen is sampled, a negative result does not reliably rule out infection. Each lumen of multiple-lumen CVCs should be considered as a potential source of CRBSI...

..difficile, and the effect of the use of alcohol-based hand hygiene agents...

..C. perfringens is a potentially important cause of infective AAD and can be detected with the C. perfringens enterotoxin ELISA kit, although weak positive results should be considered with caution...

..This points to potential anomalies in the assessment of the prevalence of resistance when relying on recovery of resistant bacteria by culture...

..difficile is endemic requires further study, particularly given the reduced antibiotic susceptibility to all fluoroquinolones of the readily transmissible UK C. difficile clone...

..PPNMT can reduce the incidence of MRSA SSls after orthopaedic surgery, probably by reducing nasal MRSA carriage in the endemic setting, without selecting for mupirocin resistance...

..aureus and MRSA in orthopaedic and vascular surgery patients. Despite four years of use of PPNMTT, there was no evidence of sustained emergence or spread of mupirocin resistance...

..Not all infection is preventable. However, much is possible and is indeed obligatory to avoid unnecessary infection, and attendant morbidity, mortality and, increasingly, litigation...

..Although CVC removal was associated with a high cure rate, it did not guarantee treatment success...

..Vaccination to prevent C. difficile infection, particularly in high-risk elderly patients managed within institutions where C. difficile is endemic, is a worthwhile therapeutic goal...

..aureus PT 53,85 isolates were recovered. Control of S. aureus in our regional neonatal unit, in particular an endemic MSSA strain, was maintained when topical umbilical hexachlorophane powder was substituted with 1% chlorhexidine powder...

..The endoluminal brush technique can be safely used to diagnose CRBSI without the need for CVC removal, provided that the brush is not allowed to protrude beyond the tip of the catheter...

..However, storage at -20 degrees C has a detrimental effect upon C difficile cytotoxin, and multiple cycles of freezing and thawing may further adversely effect toxin titres...

..We determined the effect of combining urine and cervical swab specimens in the clinic setting on the sensitivity of C trachomatis polymerase chain reaction (PCR) testing...

..05). In routine cardiothoracic surgery patients, extending routine perioperative antibiotic prophylaxis until all IVCs have been removed does not influence rates of IVC colonization...

..In animal models, corn starch, the material used as glove powder, promotes wound infection. Infection control teams need to be aware of this evidence and should support switching from use of powdered to powder free gloves...

..To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among older residents of care homes in Leeds, United Kingdom, and to identify resident and care home risk factors for carriage...

..We evaluated the role of the AOLC test in early detection or exclusion of CRBSI and compared the cost of managing patients with suspected CRBSI...