Dale N Gerding

Summary

Country: USA

Publications

  1. doi request reprint Management of Clostridium difficile infection: thinking inside and outside the box
    Dale N Gerding
    Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois 60141, USA
    Clin Infect Dis 51:1306-13. 2010
  2. doi request reprint Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain
    Jennifer R O'Connor
    Research Service, Edward Hines Jr VA Hospital, Hines, Illinois 60141, USA
    Gastroenterology 136:1913-24. 2009
  3. doi request reprint Global epidemiology of Clostridium difficile infection in 2010
    Dale N Gerding
    Research Service, Edward Hines Jr VA Hospital, Hines, IL 60611, USA
    Infect Control Hosp Epidemiol 31:S32-4. 2010
  4. pmc Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin
    Iris Figueroa
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 55:S104-9. 2012
  5. ncbi request reprint Clostridium difficile infection prevention: biotherapeutics, immunologics, and vaccines
    Dale N Gerding
    Department of Medicine, Loyola University, Chicago Stritch School of Medicine, Maywood, Illinois 60153, USA
    Discov Med 13:75-83. 2012
  6. pmc Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium
    Richard A Stabler
    London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
    Genome Biol 10:R102. 2009
  7. doi request reprint Treatment of Clostridium difficile infection
    Dale N Gerding
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 46:S32-42. 2008
  8. doi request reprint Measures to control and prevent Clostridium difficile infection
    Dale N Gerding
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 46:S43-9. 2008
  9. doi request reprint Clostridium difficile 30 years on: what has, or has not, changed and why?
    Dale N Gerding
    Research Service, Edward Hines Jr Veterans Affairs Hospital, 5000 S 5th Avenue, Building 1, Room C344, Hines, IL 60141, USA
    Int J Antimicrob Agents 33:S2-8. 2009
  10. doi request reprint Vaccination with parenteral toxoid B protects hamsters against lethal challenge with toxin A-negative, toxin B-positive clostridium difficile but does not prevent colonization
    Farida Siddiqui
    Research Service, Hines VA Hospital, Hines, IL 60141, USA
    J Infect Dis 205:128-33. 2012

Collaborators

Detail Information

Publications54

  1. doi request reprint Management of Clostridium difficile infection: thinking inside and outside the box
    Dale N Gerding
    Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois 60141, USA
    Clin Infect Dis 51:1306-13. 2010
    ..difficile. These reports provide optimism that more-effective management of CDI is forthcoming...
  2. doi request reprint Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain
    Jennifer R O'Connor
    Research Service, Edward Hines Jr VA Hospital, Hines, Illinois 60141, USA
    Gastroenterology 136:1913-24. 2009
    ..Control of hospital outbreaks caused by BI/NAP1/027 is difficult but possible through a combination of barrier precautions, environmental cleaning, and antimicrobial stewardship...
  3. doi request reprint Global epidemiology of Clostridium difficile infection in 2010
    Dale N Gerding
    Research Service, Edward Hines Jr VA Hospital, Hines, IL 60611, USA
    Infect Control Hosp Epidemiol 31:S32-4. 2010
    ..The epidemic is due in part to the emergence of a previously rare and now more lethal C. difficile strain variously named group BI, ribotype 027, and North American pulsed‐field gel electrophoresis type 1...
  4. pmc Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin
    Iris Figueroa
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 55:S104-9. 2012
    ..Caution in generalizing these observations is required, because the patients studied were younger and more likely to be from Canadian sites than were patients with recurrence who did not provide isolates...
  5. ncbi request reprint Clostridium difficile infection prevention: biotherapeutics, immunologics, and vaccines
    Dale N Gerding
    Department of Medicine, Loyola University, Chicago Stritch School of Medicine, Maywood, Illinois 60153, USA
    Discov Med 13:75-83. 2012
    ....
  6. pmc Comparative genome and phenotypic analysis of Clostridium difficile 027 strains provides insight into the evolution of a hypervirulent bacterium
    Richard A Stabler
    London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
    Genome Biol 10:R102. 2009
    ..difficile (CD196), a recent epidemic and hypervirulent 027 (R20291) and a previously sequenced PCR-ribotype 012 strain (630)...
  7. doi request reprint Treatment of Clostridium difficile infection
    Dale N Gerding
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 46:S32-42. 2008
    ..difficile vaccine...
  8. doi request reprint Measures to control and prevent Clostridium difficile infection
    Dale N Gerding
    Hines Veterans Affairs Hospital, Hines, IL 60141, USA
    Clin Infect Dis 46:S43-9. 2008
    ..The efficacy of metronidazole or vancomycin prophylaxis to prevent CDI in patients who are receiving other antimicrobials is unproven, and treatment with these agents is ineffective against C. difficile in asymptomatic carriers...
  9. doi request reprint Clostridium difficile 30 years on: what has, or has not, changed and why?
    Dale N Gerding
    Research Service, Edward Hines Jr Veterans Affairs Hospital, 5000 S 5th Avenue, Building 1, Room C344, Hines, IL 60141, USA
    Int J Antimicrob Agents 33:S2-8. 2009
    ..difficile organism and the host at the mucosal level, so that biotherapeutic and vaccine strategies for the prevention of CDI can be developed...
  10. doi request reprint Vaccination with parenteral toxoid B protects hamsters against lethal challenge with toxin A-negative, toxin B-positive clostridium difficile but does not prevent colonization
    Farida Siddiqui
    Research Service, Hines VA Hospital, Hines, IL 60141, USA
    J Infect Dis 205:128-33. 2012
    ..To determine the role of toxin B in these strains, we immunized hamsters with a toxoid prepared from purified toxin B to determine whether they would be protected from lethal challenge with an A-/B+ strain of C. difficile...
  11. doi request reprint Rifaximin Redux: treatment of recurrent Clostridium difficile infections with rifaximin immediately post-vancomycin treatment
    Stuart Johnson
    Research Service, Hines VA Hospital, Hines, IL 60141 3030, USA
    Anaerobe 15:290-1. 2009
    ..C. difficile isolates from one of the two patients who failed treatment had an MIC of >256 microg/ml to rifampin. Serial therapy with vancomycin, followed by rifaximin remains an option for some patients with multiple CDI recurrences...
  12. doi request reprint Distribution of Clostridium difficile strains from a North American, European and Australian trial of treatment for C. difficile infections: 2005-2007
    Adam K Cheknis
    Research Service, Hines VA Hospital, Hines, IL 60141 3030, USA
    Anaerobe 15:230-3. 2009
    ..International surveillance of C. difficile strains is important to document the changing epidemiology of this enteric pathogen that continues to cause healthcare facility outbreaks and sporadic infections in other settings...
  13. ncbi request reprint A mouse model of Clostridium difficile-associated disease
    Xinhua Chen
    Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
    Gastroenterology 135:1984-92. 2008
    ..The aim of this study was to establish a mouse model of antibiotic-induced C. difficile-associated disease (CDAD) that more closely resembles human disease...
  14. pmc Rifampin and rifaximin resistance in clinical isolates of Clostridium difficile
    Jennifer R O'Connor
    Hines VA Hospital, 5000 South 5th Ave, Hines, IL 60141 3030, USA
    Antimicrob Agents Chemother 52:2813-7. 2008
    ..We propose that rifaximin resistance in C. difficile results from mutations in RpoB and that rifampin resistance predicts rifaximin resistance for this organism...
  15. pmc International typing study of toxin A-negative, toxin B-positive Clostridium difficile variants
    Stuart Johnson
    Department of Medicine, Veterans Administration Chicago Health Care System, Lakeside Division, and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
    J Clin Microbiol 41:1543-7. 2003
    ..difficile disease in the United Kingdom and the United States. C. difficile A(-)/B(+) variants of apparent clonal origin are widely distributed in Europe and North America...
  16. ncbi request reprint Onset of symptoms and time to diagnosis of Clostridium difficile-associated disease following discharge from an acute care hospital
    Heidi T Chang
    Department of Veterans Affairs, Midwest Center for Health Services and Policy Research and Research Service, Edward Hines Jr Veterans Affairs Hospital, Hines, IL 60141, USA
    Infect Control Hosp Epidemiol 28:926-31. 2007
    ..To identify patients with a diagnosis of Clostridium difficile-associated disease (CDAD) in the ambulatory care setting and determine the relationship of symptom onset and diagnosis to prior hospitalization and exposure to antimicrobials...
  17. pmc Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain
    Laurica A Petrella
    Edward Hines Jr VA Hospital, Hines, Illinois, USA
    Clin Infect Dis 55:351-7. 2012
    ..difficile infection (CDI). The treatment response of patients infected with this strain is uncertain...
  18. ncbi request reprint Prevention of fatal Clostridium difficile-associated disease during continuous administration of clindamycin in hamsters
    Michelle M Merrigan
    Infectious Disease Section, Department of Medicine, Veterans Affairs Chicago Health Care System, Lakeside Division, Chicago, Illinois, USA
    J Infect Dis 188:1922-7. 2003
    ..The benefits of use of Cm-resistant nontoxigenic C. difficile to prevent CDAD must be balanced against the risk that resistance might be transferred to other enteric bacteria...
  19. doi request reprint New approach to the management of Clostridium difficile infection: colonisation with non-toxigenic C. difficile during daily ampicillin or ceftriaxone administration
    Michelle M Merrigan
    Research Service, Edward Hines Jr Veterans Affairs Hospital, Hines, IL 60141, USA
    Int J Antimicrob Agents 33:S46-50. 2009
    ....
  20. pmc Human hypervirulent Clostridium difficile strains exhibit increased sporulation as well as robust toxin production
    Michelle Merrigan
    Loyola University Medical Center, Maywood, IL, USA
    J Bacteriol 192:4904-11. 2010
    ..Increased sporulation, potentially in synergy with robust toxin production, may therefore contribute to the widespread disease now associated with hypervirulent C. difficile strains...
  21. pmc In vitro activities of 15 antimicrobial agents against 110 toxigenic clostridium difficile clinical isolates collected from 1983 to 2004
    David W Hecht
    Microbiology and Immunology, Loyola University Medical Center, Maywood, IL 60153, USA
    Antimicrob Agents Chemother 51:2716-9. 2007
    ..These in vitro susceptibility results are encouraging and support continued evaluation of selected antimicrobials in clinical trials of treatment for CDAD...
  22. ncbi request reprint Infection of hamsters with historical and epidemic BI types of Clostridium difficile
    Nadia Razaq
    Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
    J Infect Dis 196:1813-9. 2007
    ..Our objective was to compare, in hamsters, the virulence of a historical nonepidemic BI type, BI1, with that of 2 recent epidemic BI types, BI6 and BI17, and with that of 2 standard toxigenic strains, K14 and 630...
  23. pmc Nontoxigenic Clostridium difficile protects hamsters against challenge with historic and epidemic strains of toxigenic BI/NAP1/027 C. difficile
    Kristin J Nagaro
    Hines VA Hospital, Hines, Illinois, USA
    Antimicrob Agents Chemother 57:5266-70. 2013
    ..difficile infection caused by the BI6 epidemic strain. Prevention of C. difficile infection caused by the epidemic BI6 strain may be more challenging than that of infections caused by historic BI1 and non-BI C. difficile strains. ..
  24. ncbi request reprint Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin
    Stuart Johnson
    Loyola University Medical Center, Maywood, IL, USA
    Clin Infect Dis 44:846-8. 2007
    ..difficile was recovered after treatment. A controlled trial for treating recurrent Clostridium difficile-associated diarrhea appears to be warranted...
  25. doi request reprint Clostridium difficile infection rates and spectrum of disease among peripartum women at one hospital from 2003 to 2007 with molecular typing analysis of recovered Clostridium difficile isolates
    Anilrudh A Venugopal
    Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
    Am J Infect Control 39:206-11. 2011
    ..We determined the incidence and clinical features of CDI in peripartum women in the Loyola University Medical Center system and describe typing of C difficile isolates by restriction endonuclease analysis (REA)...
  26. doi request reprint Clostridium difficile infection and limitations of markers for severity in patients with hematologic malignancy
    Michael S Wang
    Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
    Infect Control Hosp Epidemiol 34:127-32. 2013
    ..To describe characteristics of Clostridium difficile infection (CDI) and markers of severe CDI among patients with hematologic malignancies...
  27. ncbi request reprint Predominance of a single restriction endonuclease analysis group with intrahospital subgroup diversity among Clostridium difficile isolates at two Chicago hospitals
    Endale T Mekonen
    Department of Medicine, Chicago Healthcare System, Northwestern University Medical School, Illinois, USA
    Infect Control Hosp Epidemiol 23:648-52. 2002
    ..difficile isolates...
  28. doi request reprint Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands
    Umair Jabbar
    Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois, USA
    Infect Control Hosp Epidemiol 31:565-70. 2010
    ..Alcohol is not effective against Clostridium difficile spores. We examined the retention of C. difficile spores on the hands of volunteers after ABHR use and the subsequent transfer of these spores through physical contact...
  29. ncbi request reprint Measuring the severity of Clostridium difficile infection: implications for management and drug development
    Jaime Belmares
    Division of Infectious Diseases, Loyola University Chicago Medical Center, 2160 South First Avenue, Building 54, Room 149, Maywood, IL 60153, USA
    Expert Rev Anti Infect Ther 6:897-908. 2008
    ..The availability of a standardized and validated system for stratifying CDI severity could improve patient management and potentially accelerate the development of new treatment agents...
  30. ncbi request reprint Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system
    Jaime Belmares
    Infectious Disease Section, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
    J Infect 55:495-501. 2007
    ..To determine the response rate of Clostridium difficile disease (CDD) to treatment with metronidazole and assess a scoring system to predict response to treatment with metronidazole when applied at the time of CDD diagnosis...
  31. doi request reprint Clostridium difficile infection in 2010: advances in pathogenesis, diagnosis and management of CDI
    Dale N Gerding
    Edward Hines Jr Veterans Affairs Hospital, 5000 South 5th Avenue, Hines, IL 60141, USA
    Nat Rev Gastroenterol Hepatol 8:67-8. 2011
    ..Both toxins A and B are essential virulence factors, pcr diagnostic testing is rapid, sensitive and specific, and recurrent CDI can be prevented using monoclonal antibodies to toxins A and B...
  32. ncbi request reprint Colonization for the prevention of Clostridium difficile disease in hamsters
    Susan P Sambol
    Infectious Disease Section, Department of Medicine, Veterans Affairs Chicago Health Care System, Lakeside Division, Chicago, Illinois, USA
    J Infect Dis 186:1781-9. 2002
    ....
  33. ncbi request reprint Community-Associated Clostridium difficile Infection among Veterans with Spinal Cord Injury and Disorder
    Salva N Balbale
    Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
    Infect Control Hosp Epidemiol 35:577-80. 2014
    ..Generally, patients with CA-CDI had less comorbidity, less severe CDI, and lower likelihood of antibiotic exposure. ..
  34. doi request reprint Recurrence of Clostridium difficile infection among veterans with spinal cord injury and disorder
    Swetha Ramanathan
    Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare and Spinal Cord Injury Quality Enhancement Research Initiative SCI QUERI, Edward Hines Jr VA Hospital, Hines, IL School of Public Health, University of Illinois, Chicago, IL Electronic address
    Am J Infect Control 42:168-73. 2014
    ..Therefore, the objective of this study was to identify risk factors associated with recurrence of CDI among Veterans with SCI/D...
  35. pmc Protection from Clostridium difficile infection in CD4 T Cell- and polymeric immunoglobulin receptor-deficient mice
    Pehga F Johnston
    Loyola University Chicago Stritch School of Medicine, Department of Microbiology and Immunology, Maywood, Illinois, USA
    Infect Immun 82:522-31. 2014
    ..We conclude that protection from CDI can occur by several mechanisms and that the mechanism of protection is determined by the state of immunocompetence of the host...
  36. ncbi request reprint A hospital outbreak of Clostridium difficile disease associated with isolates carrying binary toxin genes
    M Catherine McEllistrem
    University of Pittsburgh School of Medicine, Pittsburgh, PA 15213 2582, USA
    Clin Infect Dis 40:265-72. 2005
    ..The binary toxin genes cdt and cdtB have been detected in approximately 5% of Clostridium difficile strains. Severe C. difficile disease (CDD) may be associated with strains that carry the binary toxin genes...
  37. ncbi request reprint New definitions will help, but cultures are critical for resolving unanswered questions about Clostridium difficile
    Dale N Gerding
    Infect Control Hosp Epidemiol 28:113-5. 2007
  38. pmc Comparison of seven techniques for typing international epidemic strains of Clostridium difficile: restriction endonuclease analysis, pulsed-field gel electrophoresis, PCR-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat an
    George Killgore
    Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
    J Clin Microbiol 46:431-7. 2008
    ..All techniques appear to be capable of detecting outbreak strains, but only REA and MLVA showed sufficient discrimination to distinguish strains from different outbreaks...
  39. ncbi request reprint Difference in the incidence of Clostridium difficile among patients infected with human immunodeficiency virus admitted to a public hospital and a private hospital
    Joseph J Pulvirenti
    Infect Control Hosp Epidemiol 23:641-7. 2002
    ..To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HIV) in two different hospitals...
  40. doi request reprint Clinical recognition and diagnosis of Clostridium difficile infection
    John G Bartlett
    Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
    Clin Infect Dis 46:S12-8. 2008
    ..Often overlooked aspects of this diagnosis are high white blood cell counts (which are sometimes in the leukemoid range) and hypoalbuminemia...
  41. ncbi request reprint Binary toxin-producing, large clostridial toxin-negative Clostridium difficile strains are enterotoxic but do not cause disease in hamsters
    Barbara Geric
    Department of Biology, University of Ljubljana, Ljubljana, Slovenia
    J Infect Dis 193:1143-50. 2006
    ..Binary toxin CDT may play an adjunctive role to toxins A and B in the pathogenesis of C. difficile-associated disease but by itself may not be sufficient to cause disease...
  42. pmc Multilocus variable-number tandem-repeat analysis for investigation of Clostridium difficile transmission in Hospitals
    Jane W Marsh
    Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Medical Center, Division of Hospital Epidemiology and Infection Control, 865 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA
    J Clin Microbiol 44:2558-66. 2006
    ..Thus, MLVA is an objective, portable genotyping method that permits reliable detection of C. difficile outbreaks and can aid epidemiologic investigations of nosocomial transmission...
  43. ncbi request reprint Metronidazole for Clostridium difficile-associated disease: is it okay for Mom?
    Dale N Gerding
    Clin Infect Dis 40:1598-600. 2005
  44. doi request reprint Clostridium difficile-associated disease treatment response depends on definition of cure
    Steven J Lawrence
    Clin Infect Dis 45:1648; author reply 1649-51. 2007
  45. ncbi request reprint Epidemiology and outcome of Clostridium difficile infection and diarrhea in HIV infected inpatients
    Joseph J Pulvirenti
    Cook County Hospital, Rush Medical College, Hektoen Institute, Chicago, Illinois, USA
    Diagn Microbiol Infect Dis 44:325-30. 2002
    ..02) and received more antibiotics (p =.002). C. difficile was frequently present in our HIV infected patients, especially those with advanced HIV disease, but appeared to have little impact on morbidity or mortality...
  46. pmc Toxinotype V Clostridium difficile in humans and food animals
    Michael A Jhung
    Centers for Disease Control and Prevention, Atlanta, Georgia, USA
    Emerg Infect Dis 14:1039-45. 2008
    ..Further study is needed to understand the epidemiology of CDAD caused by toxinotype V C. difficile, including the potential of foodborne transmission to humans...
  47. ncbi request reprint Revised nomenclature of Clostridium difficile toxins and associated genes
    Maja Rupnik
    Department of Biology, University of Ljubljana, Vecna pot 111, 1000 Ljubljana, Slovenia
    J Med Microbiol 54:113-7. 2005
    ..difficile toxins and other related large clostridial toxins produced by Clostridium sordellii and Clostridium novyi, and corresponding toxin genes, as well as toxin production types of C. difficile strains...
  48. ncbi request reprint Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship
    Timothy H Dellit
    Harborview Medical Center and the University of Washington, Seattle, USA
    Clin Infect Dis 44:159-77. 2007
  49. ncbi request reprint Staphylococcus aureus and Clostridium difficile cause distinct pseudomembranous intestinal diseases
    M Kent Froberg
    University of Minnesota, Duluth, Minnesota, USA
    Clin Infect Dis 39:747-50. 2004
    ..difficile infection, as well as confluent, loosely adherent pseudomembranes in the small bowel. Identification of MRSA in the small bowel pseudomembrane by polymerase chain reaction supports S. aureus as an enteric pathogen...
  50. ncbi request reprint Genotypic and phenotypic analysis of Clostridium difficile correlated with previous antibiotic exposure
    Matthew H Samore
    VA Salt Lake City Health Care System, and Division of Clinical Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
    Microb Drug Resist 12:23-8. 2006
    ..Resistance of specific C. difficile strains to clindamycin and other antimicrobial agents may contribute to their hospital dissemination and explain, in part, the propensity of clindamycin to trigger nosocomial outbreaks...
  51. ncbi request reprint Distribution of Clostridium difficile variant toxinotypes and strains with binary toxin genes among clinical isolates in an American hospital
    Barbara Geric
    Department of Biology, University of Ljubljana, Vecna pot 111, 1000 Ljubljana
    J Med Microbiol 53:887-94. 2004
    ..8 %), all of which were variant toxinotypes. Toxin variants of C. difficile are pathogenic and commonly isolated and need to be considered when evaluating new diagnostic testing strategies for C. difficile disease...
  52. ncbi request reprint Clindamycin, cephalosporins, fluoroquinolones, and Clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem
    Dale N Gerding
    Clin Infect Dis 38:646-8. 2004
  53. pmc Frequency of binary toxin genes among Clostridium difficile strains that do not produce large clostridial toxins
    Barbara Geric
    Department of Biology, University of Ljubljana, Ljubljana, Slovenia
    J Clin Microbiol 41:5227-32. 2003
    ..This previously unknown variation was found in three isolates that were unrelated by REA typing. LCT-negative, binary toxin-positive strains were isolated from symptomatic and asymptomatic patients and from the hospital environment...
  54. ncbi request reprint An epidemic, toxin gene-variant strain of Clostridium difficile
    L Clifford McDonald
    Epidemiology and Laboratory Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
    N Engl J Med 353:2433-41. 2005
    ..difficile with increased virulence, resistance, or both...