Original Article
A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile–Associated Diarrhea with High Morbidity and Mortality
N Engl J Med 2005; 353:2442-2449December 8, 2005
- Abstract
Background
In March 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficile–associated diarrhea.
Methods
In 2004 we conducted a prospective study at 12 Quebec hospitals to determine the incidence of nosocomial C. difficile–associated diarrhea and its complications and a case–control study to identify risk factors for the disease. Isolates of C. difficile were typed by pulsed-field gel electrophoresis and analyzed for binary toxin genes and partial deletions in the toxin A and B repressor gene tcdC. Antimicrobial susceptibility was evaluated in a subgroup of isolates.
Results
A total of 1703 patients with 1719 episodes of nosocomial C. difficile–associated diarrhea were identified. The incidence was 22.5 per 1000 admissions. The 30-day attributable mortality rate was 6.9 percent. Case patients were more likely than matched controls to have received fluoroquinolones (odds ratio, 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 found in 129 of 157 isolates (82.2 percent), and the binary toxin genes and partial deletions in the tcdC gene were present in 132 isolates (84.1 percent).
Conclusions
A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C. difficile–associated diarrhea. Exposure to fluoroquinolones or cephalosporins was a risk factor.
Media in This Article
Figure 1
Incidence of Nosocomial Clostridium difficile–Associated Diarrhea over Time among the 12 Study Hospitals.Table 1
Characteristics of 1703 Patients with Clostridium difficile–Associated Diarrhea.Article Activity
- Article
Clostridium difficile is the leading cause of nosocomial infectious diarrhea.1 The most important risk factor for C. difficile–associated diarrhea is prior antibiotic use.2 Some patients remain asymptomatic after exposure to C. difficile, whereas illness ranging from mild diarrhea to fulminant colitis develops in others.2 Only 1 to 5 percent of affected patients have severe disease, leading to colectomy, intensive care, or death.3,4
The best-described C. difficile virulence factors are toxins A and B, encoded by the genes tcdA and tcdB, respectively.5 Together with two regulatory genes (tcdC and tcdD) and a porin gene (tcdE), they form the chromosomal pathogenicity locus.6,7 The expression of tcdA and tcdB is down-regulated by the tcdC gene. Polymorphisms or partial deletions of tcdC may lead to increased production of toxin A and toxin B.7 In addition, a separate binary toxin has been described in C. difficile.8 Two chromosomal genes (cdtA and cdtB), separate from the chromosomal pathogenicity locus, encode this toxin. The cdtB gene mediates cell-surface binding and intracellular translocation, whereas cdtA disrupts the assembly of the actin filament through ribosylation of adenosine diphosphate, causing cell death.9
Since March 2003, many hospitals in Montreal and its surrounding regions in Quebec have noted a rise in the incidence of C. difficile–associated diarrhea, with an accompanying increase in the proportion of cases having severe and fatal complications.10 We conducted a prospective study to evaluate the incidence, morbidity, and mortality of nosocomial C. difficile–associated diarrhea in 12 Quebec hospitals. We also performed a case–control study to identify risk factors in our patient population. We hypothesized that a common strain may have been linked to the nearly simultaneous outbreaks in multiple institutions and that this strain would demonstrate postulated virulence factors — specifically, the presence of binary toxin and partial deletions of the tcdC gene.
Methods
Participating Hospitals
From January 11 to June 26, 2004, surveillance for nosocomial C. difficile–associated diarrhea and its associated complications was implemented at 12 hospitals. The study was performed as part of the routine institutional management of outbreaks and approved by the director of professional services at each institution. Information was collected about each hospital, including the type of health care facility, bed capacity, and age-specific admissions.
Surveillance Definitions
C. difficile–associated diarrhea was defined by the presence of diarrhea and a positive assay for C. difficile toxin A, toxin B, or both; by the sudden onset of diarrhea with no alternative explanation and a diagnosis of pseudomembranous colitis on the basis of endoscopy; or by histologic evidence of the condition. A case was considered nosocomial if symptoms started 72 hours or more after a patient was admitted or if C. difficile–associated diarrhea was diagnosed within one month after a previous admission. An episode was considered new if it occurred more than eight weeks after a previous diagnosis of C. difficile–associated diarrhea. Neonates and psychiatric inpatients were excluded.
Patients' Characteristics and Outcome Measures
We collected data on each patient's age and sex, the ward in which C. difficile–associated diarrhea was acquired, the diagnosis-related group, and whether he or she had received antibiotics in the hospital within six weeks before the C. difficile diagnosis. The outcomes measured included the crude and attributable 30-day mortality rates and the rates of colectomy and disease requiring intensive care owing to C. difficile–associated diarrhea. For each death, two physicians judged independently whether C. difficile–associated diarrhea was an attributable cause, a contributing cause, or unrelated to the cause of death. It was deemed the attributable cause of death if the physician judged that the patient would not have died within 30 days in the absence of C. difficile–associated diarrhea. In the case of a disagreement, the two physicians reached a consensus. A case of C. difficile–associated diarrhea was classified as severe if the patient died within 30 days after the diagnosis attributable to this condition or if the patient required colectomy or intensive care as a result.
Case–Control Study
We used a computer-generated random sample of 15 percent of patients with C. difficile–associated diarrhea in the prospective study. We then selected one control patient per patient with C. difficile–associated diarrhea from a computer-generated list of patients who had been admitted and discharged from the same institution during the study period. Control patients were matched with case patients by age (within five years), Charlson index, date of admission (within one month), ward, and length of time at risk for C. difficile–associated diarrhea. For case patients, the length of time at risk was defined as the number of days from admission to the development of C. difficile–associated diarrhea; for controls, it was defined as the number of days from admission to discharge. Controls had no known history of C. difficile–associated diarrhea. We also collected information on potential covariates such as the type of hospital (community or university-affiliated) and the use or nonuse of antibiotics, enteral feeding, chemotherapy, proton-pump inhibitors, and histamine H2–blockers within six weeks before the diagnosis of C. difficile–associated diarrhea for the case patients and within six weeks before discharge for the controls.
Detection of C. difficile Toxin
Routine laboratory procedures were used at each institution to detect C. difficile toxin. Ten hospital laboratories used cell-culture cytotoxin assays to detect toxin B according to standard methods.11 Two hospital laboratories used enzyme immunoassays according to the manufacturer's instructions: one used the Triage Micro C. difficile panel (Biosite) for the detection of glutamate dehydrogenase and toxin A in stool samples, and the other used the ColorPAC Toxin A kit (Becton Dickinson). For the Triage Micro C. difficile panel, samples were also tested by cell culture for toxin B if the glutamate dehydrogenase and toxin A results were discordant.
Culture of C. difficile
Participating institutions were asked to submit 10 consecutive stool samples that were positive for toxin A or B from patients with nosocomial C. difficile–associated diarrhea. Samples were treated with alcohol, and the mixture was inoculated onto cefoxitin–cycloserine fructose agar plates (Oxoid Basingstoke).11 After incubation at 35°C for 48 hours under anaerobic conditions, isolates were confirmed to be C. difficile on the basis of Gram's staining, typical odor, chartreuse fluorescence under ultraviolet light, and the presence of C. difficile antigen on Microscreen latex agglutination (Microgen Bioproducts). Isolates of C. difficile were frozen at –70°C in brain–heart infusion broth and 10 percent glycerol pending further characterization.
Pulsed-Field Gel Electrophoresis
To determine whether the observed epidemiologic features were related to a clonal outbreak, pulsed-field gel electrophoresis (PFGE) of C. difficile isolates was performed according to the method described by Fawley and Wilcox.12 Gels were stained with ethidium bromide and photographed with the use of Image Master software (Bio-Rad Laboratories Canada). A molecular-weight marker and a reproducible C. difficile isolate were included in each gel migration. The relatedness of the various isolates was determined according to the criteria of Tenover et al.13
Analyses for Binary Toxin Genes and Partial Deletions of the tcdC Gene
The presence of binary toxin genes (cdtA and cdtB) and partial deletions of the tcdC gene was identified according to the methods of Gonçalves et al. and Cohen et al., respectively.14,15 The polymerase-chain-reaction (PCR) assays for cdtA and cdtB were performed separately, and the results were analyzed independently. Crude DNA was extracted from isolates of C. difficile by means of the InstaGene Matrix kit (BioRad) according to the manufacturer's instructions. We used C. difficile Collection de l'Institut Pasteur 107932 as a positive control for binary toxin genes and C. difficile American Type Culture Collection (ATCC) 43255, C. spiroforme ATCC 29900, and Staphylococcus aureus ATCC 25923 as negative controls for binary toxin genes. Amplified products underwent electrophoresis, were stained with ethidium bromide, and were photographed with the use of a Land camera (Polaroid). DNA sequencing of both strands of the PCR products was performed according to standard protocols, and the results were analyzed with the use of an ABI3700XL sequencer (Applied Biosystems).
Susceptibility Testing
Testing of the C. difficile isolates for susceptibility to gatifloxacin, levofloxacin, moxifloxacin, ciprofloxacin, clindamycin, metronidazole, and vancomycin was performed with the use of the Etest (AB Biodisk), a 1.0 McFarland inoculum, brucella agar, and anaerobic conditions. As a means of quality control, appropriate ATCC strains of Escherichia coli, S. aureus, and Bacteroides fragilis were used for the tested antibiotics, according to the guidelines of the Clinical and Laboratory Standards Institute.16
Statistical Analysis
Epidemiologic and molecular data were collected and interpreted independently. A relational database was developed between patient identifiers and isolate identifiers. A Yates-corrected chi-square test was used for the analysis of proportions. If a cell value was less than 5 in the two-by-two table, Fisher's exact test was used. All P values were two-sided. Conditional logistic regression was used in the case–control analysis to estimate the odds ratio of C. difficile–associated diarrhea associated with the use of specific classes of antibiotic. All analyses were adjusted for the concurrent use of other antimicrobial agents, as well as for all potential covariates. Analyses were performed with the use of SAS software (version 9.1, SAS Institute).
Results
Description of Hospitals
Of the 12 participating hospitals, 8 were in Montreal, 2 were in Sherbrooke, 1 was in Laval, and 1 was in St. Hyacinthe. There were eight university-affiliated centers and four community hospitals. The bed capacity ranged from 256 to 705. The number of admissions ranged from 5188 to 23,485 per year.
Patient Population
A total of 1703 patients had 1719 episodes that met the case definition of nosocomial C. difficile–associated diarrhea. The patients' characteristics and their use of antibiotics in the hospital within the six weeks before the diagnosis are shown in Table 1Table 1
Characteristics of 1703 Patients with Clostridium difficile–Associated Diarrhea.. The most common classes of antibiotic administered were cephalosporins and fluoroquinolones. Data on antibiotic use were available for only 1512 patients (88.8 percent).Incidence and Outcome Measures
The overall mean incidence of C. difficile–associated diarrhea was 22.5 per 1000 admissions (range, 10.2 to 39.9) during the study period. The incidence increased with age (Table 2Table 2
Age-Specific Incidence and Mortality Attributed to Clostridium difficile–Associated Diarrhea.). A total of 422 patients died within 30 days after the diagnosis of C. difficile–associated diarrhea, for a crude mortality rate of 24.8 percent. Among these 422 patients, C. difficile–associated diarrhea was the attributable cause of death in 117 of the 1703 patients (6.9 percent), contributed to but was not the attributable cause of death in another 127 (7.5 percent), and was unrelated to the cause of death in 178 (10.5 percent). The attributable mortality rate increased with age (Table 2). Because of C. difficile–associated diarrhea, 110 patients (6.5 percent) required intensive care and 33 patients (1.9 percent) required colectomy.Case–Control Study
A total of 237 case patients were matched to 237 controls from 10 of the 12 institutions. Table 3Table 3
Characteristics of Case Patients and Control Patients. compares the demographic and clinical variables in the two groups. The two groups were similar with respect to age, sex, ward, and Charlson index. The median time at risk for C. difficile–associated diarrhea was 13 days among case patients and 16 days among controls (P=0.02). Case patients were more likely than controls to have been exposed to antibiotics (79.3 percent vs. 59.3 percent, P<0.001) and enteral feeding (18.6 percent vs. 11.8 percent, P=0.04). Matched logistic-regression analysis of case patients and controls revealed that exposure to cephalosporins (odds ratio, 3.8; 95 percent confidence interval, 2.2 to 6.6) and exposure to fluoroquinolones (odds ratio, 3.9; 95 percent confidence interval, 2.3 to 6.6) were significant independent risk factors for C. difficile–associated diarrhea (Table 4Table 4
Multivariate Model of the Risk of Clostridium difficile–Associated Diarrhea According to the Use of Antibiotics among Case Patients, as Compared with Matched Controls, January 11 through June 26, 2004.). Exposure to other classes of antibiotics, proton-pump inhibitors, enteral feeding, histamine H2–blockers, or chemotherapy was not significantly associated with the development of C. difficile–associated diarrhea (Table 4). To examine the risk associated with specific types of fluoroquinolones and cephalosporins, specific adjusted odds ratios were calculated (Table 4). Ciprofloxacin, gatifloxacin or moxifloxacin, and first-, second-, and third-generation cephalosporins were all independently associated with the development of C. difficile–associated diarrhea.C. difficile Isolates
Nine hospitals submitted stool samples that yielded 157 C. difficile isolates for PFGE, binary toxin analyses, and tcdC analyses. Sixty-seven isolates (42.7 percent) came from one institution. Three institutions submitted isolates outside the defined study period.
Pulsed-Field Gel Electrophoresis
All 157 isolates were typeable by PFGE, and 129 (82.2 percent) had an identical PFGE pattern, or “pulsovar,” displaying eight bands ranging from 90 to 360 kb, with the rest of the genomic DNA unresolved at more than 500 kb (Figure 1 in the Supplementary Appendix, available with the full text of this article at www.nejm.org). Of the 28 other isolates, 12 additional pulsovars were observed.
PCR Analyses for Binary Toxin Genes and Partial Deletions of the tcdC Gene
On amplification of C. difficile 16s ribosomal DNA, all 157 isolates had the expected amplicon of 270 bp, indicating successful DNA extraction and the absence of PCR inhibition. Of the 157 isolates, 132 (84.1 percent) produced the expected amplicon of 370 bp with the use of the cdtA primer set (data not shown). The same 132 isolates generated the expected amplicon of 510 bp with the use of the cdtB primer set (Figure 2A of the Supplementary Appendix). Furthermore, all 132 isolates possessing the binary toxin genes also had a partial deletion of the tcdC gene (Figure 2B of the Supplementary Appendix). Of these, 129 (97.7 percent) belonged to the predominant pulsovar and the remaining 3 (2.3 percent) belonged to three unrelated pulsovars (Figure 1 of the Supplementary Appendix). Sequence analysis showed that the predominant strain had an 18-bp deletion in the tcdC gene. For the three unrelated pulsovars with a partial deletion of the tcdC gene, two strains had a 39-bp deletion and the other had an 18-bp deletion (Figure 2C of the Supplementary Appendix).
Association with Pulsovars, Binary Toxin Genes, and Partial Deletions of the tcdC Gene
Severe C. difficile–associated diarrhea was observed in 20 of 129 patients with the predominant pulsovar (15.5 percent), as compared with 2 of 28 patients with other pulsovars (7.1 percent, P=0.37). However, severe C. difficile–associated diarrhea was observed in 22 of 132 patients with isolates that had both binary toxin genes and a partial deletion of the tcdC gene (16.7 percent), as compared with 0 of 25 patients with isolates that had neither binary toxin genes nor a partial deletion of the tcdC gene (P=0.03). The institution that submitted the majority of C. difficile isolates did not differ significantly from the other institutions in terms of its attributable mortality rate (P=0.71), its colectomy rate (P=1.0), or its patients' need for intensive care (P=0.88).
Antimicrobial Susceptibility
We assessed the antimicrobial susceptibility of 47 isolates belonging to the predominant pulsovar and 12 isolates representing the other observed PFGE patterns. All isolates were susceptible to metronidazole and vancomycin, with miminal 90 percent inhibitory concentrations of 0.5 and 1.0 μg per milliliter, respectively. All isolates of the predominant pulsovar were resistant to ciprofloxacin, moxifloxacin, gatifloxacin, and levofloxacin (minimal inhibitory concentrations of at least 32 μg per milliliter) and susceptible to clindamycin. Of the remaining 12 isolates with other PFGE patterns, all were resistant to ciprofloxacin, 4 (33.3 percent) were resistant to moxifloxacin and gatifloxacin, and 6 (50.0 percent) were resistant to levofloxacin and clindamycin. Among the three isolates that belonged to the nonpredominant pulsovar and had binary toxin genes and a partial deletion of the tcdC gene, all three were resistant to ciprofloxacin, but only one was resistant to moxifloxacin, gatifloxacin, and levofloxacin.
Discussion
We describe a simultaneous outbreak of severe C. difficile–associated diarrhea with high morbidity and mortality at multiple institutions. In a 1997 survey of 18 Canadian institutions, the mean incidence of C. difficile–associated diarrhea was 6 per 1000 admissions, and 1.5 percent of affected patients died as a direct or indirect result of this complication.17,18 In our study, the overall incidence was approximately four times that described in the Canadian survey.17 This increase was unlikely to be due to a reporting artifact, because laboratory and surveillance methods had not changed among the participating institutions. We found that the age-specific incidence of C. difficile–associated diarrhea increased markedly after the age of 50 years and the attributable mortality rate increased after the age of 60 years. This is consistent with a Swedish study that showed an age-related increase in the incidence of positive assays for C. difficile toxin.19
The PFGE results indicate that a single predominant strain was circulating among the participating Quebec institutions. This strain had the same patterns on PFGE and restriction-endonuclease analyses as an epidemic strain recently found in the United States and Europe.20,21 This strain may have been imported into Quebec or may have arisen as a result of a mutation of a previously circulating strain.
Reports have suggested that C. difficile –associated diarrhea is evolving into a more severe disease, but the link between the organism's potential virulence factors and disease severity has not been clearly established.10,22-24 The contribution of the binary toxin to virulence is not well defined. The attributable mortality rate of 6.9 percent in our study is higher than the rate of 0.5 to 5.5 percent reported in other studies and may reflect increased virulence of the predominant strain.3,4,18,25 Our study of isolates demonstrated that the presence of binary toxin genes is closely associated with partial deletions in the tcdC gene and that severe C. difficile–associated diarrhea is significantly associated with these two putative virulence factors. In addition, this genotype has been associated with levels of toxins A and B that are 16 to 23 times than those found in control strains.20 The presence of these two factors may act synergistically to result in severe C. difficile–associated diarrhea.
Exposure to antibiotics is the chief precipitant of C. difficile–associated diarrhea. Fluoroquinolones have been associated with an increased risk of C. difficile–associated diarrhea, which was corroborated in our study.24,26-28 Use of the newer fluoroquinolones among our patients may have promoted the outbreak of this fluoroquinolone-resistant strain, similar to the epidemic of a clindamycin-resistant strain among patients who received clindamycin.29 Our predominant strain was susceptible to clindamycin, and clindamycin was not an independent risk factor for C. difficile–associated diarrhea in our study.
Transmission of this predominant strain among hospitals could have occurred as the result of transfers of colonized or infected patients or, perhaps, from colonized health care workers who worked at multiple institutions. In these institutions, the majority of rooms have multiple beds, with shared toilets, facilitating transmission within hospitals. It has been demonstrated that patients housed in single rooms have a lower incidence of C. difficile–associated diarrhea than patients accommodated in double rooms.30
Our study has a number of limitations. The outcomes were measured 30 days after the first diagnosis of C. difficile–associated diarrhea, which would result in underestimates of the rates of attributable mortality, colectomy, and intensive care related to the condition. We assessed neither the severity of illness nor the presence of coexisting conditions at admission in our population. The severity of illness has been shown to be an important predictor of mortality for a variety of conditions and is also a predictor of the acquisition of C. difficile.31,32 In addition, we recorded the use of antibiotics in hospitalized patients within six weeks before the diagnosis of C. difficile–associated diarrhea but did not track the use of antibiotics before this period or before hospitalization. Finally, we did not have isolates available from all patients. However, the isolates were consecutively collected at each institution, making it unlikely that they represented a biased sample. Although isolates were overrepresented from one institution, the rate of severe C. difficile–associated diarrhea at this institution was not significantly different from the rates at the other institutions.
Coincident with the recognition of the multi-institutional outbreak of C. difficile–associated diarrhea in June 2004, major infection-control measures were implemented to curb the spread of C. difficile. The incidence of C. difficile–associated diarrhea in the study institutions subsequently decreased to 12.4 per 1000 admissions (Figure 1Figure 1
Incidence of Nosocomial Clostridium difficile–Associated Diarrhea over Time among the 12 Study Hospitals.).In summary, we have identified a predominant strain of C. difficile associated with high rates of severe disease in a number of hospitals in Quebec. Resistance to fluoroquinolones may have selected for the spread of this organism, and the presence of binary toxin genes and a partial deletion of the tcdC regulatory gene may confer increased virulence, leading to the observed high rates of morbidity and mortality. This outbreak illustrates that known pathogens can change their behavior and emerge as new threats.
Dr. Brassard is supported by the Canadian Institutes of Health Research.
Dr. Libman reports having received lecture fees from Bayer HealthCare and Sanofi-Aventis; and Dr. Miller, lecture fees from ActivBiotics and Genzyme and consulting fees from ActivBiotics and the U.S. Food and Drug Administration.
We are indebted to all the infection-control practitioners at the participating institutions for performing the surveillance for nosocomial C. difficile–associated diarrhea; to the quality-management and medical-records personnel for providing the statistics on admissions and diagnosis-related groups; to the pharmacy department for providing information on medication use; to Dr. Xiaolan Zhang and Ms. Milena Crosato for technical assistance; to Mr. Andrei Brennan and Drs. Daniela Di Iorio, Annie-Claude Labbé, Louise Dion, and Isabelle Alarie for reviewing several patients' charts; to Mr. Raun De Souza for assistance in the preparation of the manuscript; to Dr. Marcel Behr for reviewing the manuscript; to Dr. Anthony Harris for advice on the methods used for the case–control study; and to Genome Québec and Genome Canada for their support of the sequencing activities.
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@muhc.mcgill.ca.
- References
References
1
Barbut F ,Corthier G ,Charpak Y , et al. Prevalence and pathogenicity of Clostridium difficile in hospitalized patients: a French multicenter study. Arch Intern Med 1996;156:1449-1454
CrossRef | Web of Science | Medline2
Johnson S ,Gerding DN . Clostridium difficile-associated diarrhea. Clin Infect Dis 1998;26:1027-1036
CrossRef | Web of Science | Medline3
Jobe BA ,Grasley A ,Deveney KE ,Deveney CW ,Sheppard BC . Clostridium difficile colitis: an increasing hospital-acquired illness. Am J Surg 1995;169:480-483
CrossRef | Web of Science | Medline4
Rubin MS ,Bodenstein LE ,Kent KC . Severe Clostridium difficile colitis. Dis Colon Rectum 1995;38:350-354
CrossRef | Web of Science | Medline5
Poxton IR ,McCoubrey J ,Blair G . The pathogenicity of Clostridium difficile. Clin Microbiol Infect 2001;7:421-427
CrossRef | Web of Science | Medline6
Braun V ,Hundsberger T ,Leukel P ,Sauerborn M ,von Eichel-Streiber C . Definition of the single integration site of the pathogenicity locus in Clostridium difficile. Gene 1996;181:29-38
CrossRef | Web of Science | Medline7
Spigaglia P ,Mastrantonio P . Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates. J Clin Microbiol 2002;40:3470-3475
CrossRef | Web of Science | Medline8
Popoff MR ,Rubin EJ ,Gill DM ,Boquet P . Actin-specific ADP-ribosyltransferase produced by a Clostridium difficile strain. Infect Immun 1988;56:2299-2306
Web of Science | Medline9
Barth H ,Aktories K ,Popoff MR ,Stiles BG . Binary bacterial toxins: biochemistry, biology, and applications of common Clostridium and Bacillus proteins. Microbiol Mol Biol Rev 2004;68:373-402
CrossRef | Web of Science | Medline10
Pepin J ,Valiquette L ,Alary ME , et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466-472
CrossRef | Web of Science | Medline11
Allen SD, Emery CL, Lyerly DM. Clostridium. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH, eds. Manual of clinical microbiology. 8th ed. Vol. 1. Washington, D.C.: American Society of Microbiology Press, 2003:835-56.
12
Fawley WN ,Wilcox MH . Pulsed-field gel electrophoresis can yield DNA fingerprints of degradation-susceptible Clostridium difficile strains. J Clin Microbiol 2002;40:3546-3547
CrossRef | Web of Science | Medline13
Tenover FC ,Arbeit RD ,Goering RV , et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233-2239
Web of Science | Medline14
Goncalves C ,Decre D ,Barbut F ,Burghoffer B ,Petit JC . Prevalence and characterization of a binary toxin (actin-specific ADP-ribosyltransferase) from Clostridium difficile. J Clin Microbiol 2004;42:1933-1939
CrossRef | Web of Science | Medline15
Cohen SH ,Tang YJ ,Silva J Jr . Analysis of the pathogenicity locus in Clostridium difficile strains. J Infect Dis 2000;181:659-663
CrossRef | Web of Science | Medline16
Clinical and Laboratory Standards Institute (formerly National Committee for Laboratory Standards). Methods for antimicrobial susceptibility testing of anaerobic bacteria. 6th ed. Wayne, Pa.: National Committee for Clinical and Laboratory Standards, 2004. Approved standard document M11-A6.
17
Hyland M ,Ofner-Agostini M ,Miller M ,Paton S ,Gourdeau M ,Ishak M . Nosocomial Clostridium difficile-associated diarrhea in Canada: results of the Canadian Nosocomial Infection Surveillance Program (CNISP) 1997 N-CDAD Prevalence Surveillance Project. Can J Infect Dis 2001;12:81-88
Medline18
Miller MA ,Hyland M ,Ofner-Agostini M ,Gourdeau M ,Ishak M . Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol 2002;23:137-140
CrossRef | Web of Science | Medline19
Karlstrom O ,Fryklund B ,Tullus K ,Burman LG . A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. Clin Infect Dis 1998;26:141-145
CrossRef | Web of Science | Medline20
Warny M ,Pepin J ,Fang A , et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079-1084
CrossRef | Web of Science | Medline21
McDonald LC ,Killgore GE ,Thompson A , et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433-2441
Full Text | Web of Science | Medline22
Morris AM ,Jobe BA ,Stoney M ,Sheppard BC ,Deveney CW ,Deveney KE . Clostridium difficile colitis: an increasingly aggressive iatrogenic disease? Arch Surg 2002;137:1096-1100
CrossRef | Web of Science | Medline23
Dallal RM ,Harbrecht BG ,Boujoukas AJ , et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363-372
CrossRef | Web of Science | Medline24
Muto CA ,Pokrywka M ,Shutt K , et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273-280
CrossRef | Web of Science | Medline25
Kyne L ,Merry C ,O'Connell B ,Kelly A ,Keane C ,O'Neill D . Factors associated with prolonged symptoms and severe disease due to Clostridium difficile. Age Ageing 1999;28:107-113
CrossRef | Web of Science | Medline26
Lai KK ,Melvin ZS ,Menard MJ ,Kotilaninen HR ,Baker S . Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control. Infect Control Hosp Epidemiol 1997;18:628-632
CrossRef | Web of Science | Medline27
McCusker ME ,Harris AD ,Perencevich E ,Roghmann MC . Fluoroquinolone use and Clostridium difficile-associated diarrhea. Emerg Infect Dis 2003;9:730-733
Web of Science | Medline28
Gaynes R ,Rimland D ,Killum E , et al. Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 2004;38:640-645
CrossRef | Web of Science | Medline29
Johnson S ,Samore MH ,Farrow KA , et al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341:1645-1651
Full Text | Web of Science | Medline30
Samore MH ,Venkataraman L ,DeGirolami PC ,Arbeit RD ,Karchmer AW . Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32-40
CrossRef | Web of Science | Medline31
McFarland LV ,Surawicz CM ,Stamm WE . Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis 1990;162:678-684
CrossRef | Web of Science | Medline32
Green J ,Wintfeld N ,Sharkey P ,Passman LJ . The importance of severity of illness in assessing hospital mortality. JAMA 1990;263:241-246
CrossRef | Web of Science | Medline
- Citing Articles (428)
Citing Articles
1
S. Buffet-Bataillon, P. Tattevin, H. Sénéchal, M. Cormier, P. Vincent. (2012) Clostridium difficile O27 colitis: Hospital-onset but community-acquired. European Journal of Clinical Microbiology & Infectious Diseases
CrossRef2
Philip Toltzis, Michelle M. Nerandzic, Elie Saade, Mary Ann O’Riordan, Sarah Smathers, Theoklis Zaoutis, Jason Kim, Curtis J. Donskey. (2012) High Proportion of False-Positive Clostridium difficile Enzyme Immunoassays for Toxin A and B in Pediatric Patients. Infection Control and Hospital Epidemiology 33:2, 175-179
CrossRef3
S. Johnson. (2012) Clostridium difficile Toxins and Severe C. difficile Infection. Journal of Infectious Diseases 205:3, 353-354
CrossRef4
John P. Flaherty, Michael P. Angarone. 2012. Acute Diarrhea and Vomiting. , 72-83.
CrossRef5
Philippe Lagacé-Wiens, Ethan Rubinstein. (2012) Adverse reactions to β-lactam antimicrobials. Expert Opinion on Drug Safety1-19
CrossRef6
David J. Rosenberg. (2012) Infections, bacterial resistance, and antimicrobial stewardship: The emerging role of hospitalists. Journal of Hospital Medicine 7:S1, S34-S43
CrossRef7
Daniel T. Grima, Glenn F. Webb, Erika M. C. D'Agata. (2012) Mathematical Model of the Impact of a Nonantibiotic Treatment for Clostridium difficile on the Endemic Prevalence of Vancomycin-Resistant Enterococci in a Hospital Setting. Computational and Mathematical Methods in Medicine 2012, 1-8
CrossRef8
Jason W. Lancaster, S. James Matthews. (2012) Fidaxomicin: The Newest Addition to the Armamentarium Against Clostridium difficile Infections. Clinical Therapeutics 34:1, 1-13
CrossRef9
Kathleen M. McMullen, Jennie L. Mayfield, Angela Abdul-Hakim, David K. Warren, Erik R. Dubberke. (2012) Assessing colectomies due to Clostridium difficile infection: Increases in the community, but not in the referral center. American Journal of Infection Control
CrossRef10
Katharine A. Germansky, Ciarán P. Kelly. (2012) Clostridium difficile Infection. Hospital Medicine Clinics
CrossRef11
F. Schmitz. (2012) Clostridium difficile – Faktoren zu Infektion und Kolonisation im Keim und Wirt. Der Gastroenterologe 7:1, 39-40
CrossRef12
J. M. Wenisch, D. Schmid, H.-W. Kuo, E. Simons, F. Allerberger, V. Michl, P. Tesik, G. Tucek, C. Wenisch. (2011) Hospital-acquired Clostridium difficile infection: determinants for severe disease. European Journal of Clinical Microbiology & Infectious Diseases
CrossRef13
J. H. Boone, M. Goodykoontz, S. J. Rhodes, K. Price, J. Smith, K. N. Gearhart, R. J. Carman, T. M. Kerkering, T. D. Wilkins, D. M. Lyerly. (2011) Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency. European Journal of Clinical Microbiology & Infectious Diseases
CrossRef14
A. A. Venugopal, S. Johnson. (2011) Fidaxomicin: A Novel Macrocyclic Antibiotic Approved for Treatment of Clostridium difficile Infection. Clinical Infectious Diseases
CrossRef15
E.C. Keessen, W. Gaastra, L.J.A. Lipman. (2011) Clostridium difficile infection in humans and animals, differences and similarities. Veterinary Microbiology 153:3-4, 205-217
CrossRef16
Chaitanya Pant, Thomas J. Sferra, Abhishek Deshpande, Anil Minocha. (2011) Clinical approach to severe Clostridium difficile infection: Update for the hospital practitioner. European Journal of Internal Medicine 22:6, 561-568
CrossRef17
Willize E. Starre, Jaap T. Dissel, Cees Nieuwkoop. (2011) Treatment Duration of Febrile Urinary Tract Infections. Current Infectious Disease Reports 13:6, 571-578
CrossRef18
Yi-Chieh Lee, Jann-Tay Wang, An-Chi Chen, Wang-Huei Sheng, Shan-Chwen Chang, Yee-Chun Chen. (2011) Changing incidence and clinical manifestations of Clostridium difficile-associated diarrhea detected by combination of glutamate dehydrogenase and toxin assay in Northern Taiwan. Journal of Microbiology, Immunology and Infection
CrossRef19
Glen P. Carter, Julian I. Rood, Dena Lyras. (2011) The role of toxin A and toxin B in the virulence of Clostridium difficile. Trends in Microbiology
CrossRef20
Gene Y. Im, Rani J. Modayil, Cheng T. Lin, Steven J. Geier, Douglas S. Katz, Martin Feuerman, James H. Grendell. (2011) The Appendix May Protect Against Clostridium difficile Recurrence. Clinical Gastroenterology and Hepatology 9:12, 1072-1077
CrossRef21
I. T. Balassiano, E. A. Yates, R. M. C. P. Domingues, E. d. O. Ferreira. (2011) Clostridium difficile: a problem of concern in developed countries and still a mystery in Latin America.. Journal of Medical Microbiology
CrossRef22
Sahil Khanna, Darrell S Pardi, Scott L Aronson, Patricia P Kammer, Robert Orenstein, Jennifer L St Sauver, W Scott Harmsen, Alan R Zinsmeister. (2011) The Epidemiology of Community-Acquired Clostridium difficile Infection: A Population-Based Study. The American Journal of Gastroenterology
CrossRef23
Anilrudh A. Venugopal, Kathleen Riederer, Shilpa M. Patel, Susanna Szpunar, Houssein Jahamy, Sharon Valenti, Stephen P. Shemes, Riad Khatib, Leonard B. Johnson. (2011) Lack of association of outcomes with treatment duration and microbiologic susceptibility data in Clostridium difficile infections in a non-NAP1/BI/027 setting. Scandinavian Journal of Infectious Diseases1-7
CrossRef24
Loo, Vivian G., Bourgault, Anne-Marie, Poirier, Louise, Lamothe, François, Michaud, Sophie, Turgeon, Nathalie, Toye, Baldwin, Beaudoin, Axelle, Frost, Eric H., Gilca, Rodica, Brassard, Paul, Dendukuri, Nandini, Béliveau, Claire, Oughton, Matthew, Brukner, Ivan, Dascal, Andre, . (2011) Host and Pathogen Factors for Clostridium difficile Infection and Colonization. New England Journal of Medicine 365:18, 1693-1703
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Dimitri M. Drekonja, William H. Amundson, Douglas D. DeCarolis, Michael A. Kuskowski, Frank A. Lederle, James R. Johnson. (2011) Antimicrobial Use and Risk for Recurrent Clostridium difficile Infection. The American Journal of Medicine 124:11, 1081.e1-1081.e7
CrossRef26
V. C. C. Cheng, W. C. Yam, O. T. C. Lam, J. L. Y. Tsang, E. Y. F. Tse, G. K. H. Siu, J. F. W. Chan, H. Tse, K. K. W. To, J. W. M. Tai, P. L. Ho, K. Y. Yuen. (2011) Clostridium difficile isolates with increased sporulation: emergence of PCR ribotype 002 in Hong Kong. European Journal of Clinical Microbiology & Infectious Diseases 30:11, 1371-1381
CrossRef27
Diana Monge, Marisa Morosini, Isabel Millán, Carmen Pérez Canosa, Marta Manso, María Fernanda Guzman, Angel Asensio. (2011) Factores de riesgo de infección por Clostridium difficile en pacientes hospitalizados. Medicina Clínica 137:13, 575-580
CrossRef28
A. Goorhuis, S. B. Debast, J. C. Dutilh, C. M. van Kinschot, C. Harmanus, S. C. Cannegieter, E. C. Hagen, E. J. Kuijper. (2011) Type-Specific Risk Factors and Outcome in an Outbreak With 2 Different Clostridium difficile Types Simultaneously in 1 Hospital. Clinical Infectious Diseases 53:9, 860-869
CrossRef29
Andrea Lo Vecchio, George M. Zacur. (2011) Clostridium difficile infection. Current Opinion in Gastroenterology1
CrossRef30
Carroll Karen C., Bartlett John G.. (2011) Biology of Clostridium difficile : Implications for Epidemiology and Diagnosis. Annual Review of Microbiology 65:1, 501-521
CrossRef31
Li Wang, David B. Stewart. (2011) Increasing hospital costs for Clostridium difficile colitis: Type of hospital matters. Surgery 150:4, 727-735
CrossRef32
Antonio Ramos Martínez, Yolanda Romero Pizarro, Félix Martínez Arrieta, Bárbara Balandín Moreno, Elena Múñez Rubio, Karina Cuiñas León, Isabel Sánchez Romero, Blanca Cantos López de Ibargüen, Ángel Asensio Vegas. (2011) Enteritis por Clostridium difficile. Gastroenterología y Hepatología 34:8, 539-545
CrossRef33
O.A. Lungulescu, W. Cao, E. Gatskevich, L. Tlhabano, J.G. Stratidis. (2011) CSI: a severity index for Clostridium difficile infection at the time of admission. Journal of Hospital Infection 79:2, 151-154
CrossRef34
Khalid A Osman, Mohamed H Ahmed, Mahir A Hamad, Dilip Mathur. (2011) Emergency colectomy for fulminant Clostridium difficile colitis: Striking the right balance. Scandinavian Journal of Gastroenterology 46:10, 1222-1227
CrossRef35
A. Deshpande, V. Pasupuleti, D. D. K. Rolston, A. Jain, N. Deshpande, C. Pant, A. V. Hernandez. (2011) Diagnostic Accuracy of Real-time Polymerase Chain Reaction in Detection of Clostridium difficile in the Stool Samples of Patients With Suspected Clostridium difficile Infection: A Meta-Analysis. Clinical Infectious Diseases 53:7, e81-e90
CrossRef36
Gregory T. Matsuura, Mark W. Garrison. (2011) Antibiotic Collateral Damage: Resistance and Antibiotic-Associated Diarrhea. Hospital Pharmacy 46:10, 758-768
CrossRef37
Abhishek Deshpande, Chaitanya Pant, Vinay Pasupuleti, David D.K. Rolston, Anil Jain, Narayan Deshpande, Priyaleela Thota, Thomas J. Sferra, Adrian V. Hernandez. (2011) Association between Proton Pump Inhibitor therapy and Clostridium difficile infection in a Meta-Analysis. Clinical Gastroenterology and Hepatology
CrossRef38
Jason Kim, Julia F. Shaklee, Sarah Smathers, Priya Prasad, Lindsey Asti, Joan Zoltanski, Michael Dul, Michelle Nerandzic, Susan E. Coffin, Philip Toltzis, Theoklis Zaoutis. (2011) Risk Factors and Outcomes Associated With Severe Clostridium difficile Infection in Children. The Pediatric Infectious Disease Journal1
CrossRef39
A. M. Hoegh, J. B. Nielsen, A. Lester, A. Friis-Møller, K. Schønning. (2011) A multiplex, internally controlled real-time PCR assay for detection of toxigenic Clostridium difficile and identification of hypervirulent strain 027/ST-1. European Journal of Clinical Microbiology & Infectious Diseases
CrossRef40
E. Valiente, L. F. Dawson, M. D. Cairns, R. A. Stabler, B. W. Wren. (2011) Emergence of new PCR-ribotypes from the hypervirulent Clostridium difficile 027 lineage. Journal of Medical Microbiology
CrossRef41
Rajveer Hundal, Zain Kassam, Jennie Johnstone, Christine Lee, John K Marshall, John K Marshall. 2011. Fecal transplantation for recurrent or refractory Clostridium difficile diarrhea. .
CrossRef42
L. M. Green, T. Worthington, A. C. Hilton, P. A. Lambert. (2011) Genetic characterization of clinical isolates of Clostridium difficile using an optimized RAPD protocol and PCR ribotyping reveals strain diversity between two tertiary referral Trusts in the West Midlands, UK. Journal of Medical Microbiology 60:9, 1287-1291
CrossRef43
H.-J. Epple, M. Zeitz. (2011) Enteritis infectiosa. Der Internist 52:9, 1038-1046
CrossRef44
Adam P. Roberts, Peter Mullany. (2011) Tn916-like genetic elements: a diverse group of modular mobile elements conferring antibiotic resistance. FEMS Microbiology Reviews 35:5, 856-871
CrossRef45
Vincenzo Pasquale, Vincenza Jessica Romano, Maja Rupnik, Stefano Dumontet, Ivan Čižnár, F. Aliberti, F. Mauri, V. Saggiomo, Karel Krovacek. (2011) Isolation and characterization of Clostridium difficile from shellfish and marine environments. Folia Microbiologica 56:5, 431-437
CrossRef46
Stephanie R. Black, Kingsley N. Weaver, Roderick C. Jones, Kathleen A. Ritger, Laurica A. Petrella, Susan P. Sambol, Michael Vernon, Stephanie Burton, Sylvia Garcia-Houchins, Stephen G. Weber, Mary Alice Lavin, Dale Gerding, Stuart Johnson, Susan I. Gerber. (2011) Clostridium difficile Outbreak Strain BI Is Highly Endemic in Chicago Area Hospitals. Infection Control and Hospital Epidemiology 32:9, 897-902
CrossRef47
David B. Stewart, Christopher S. Hollenbeak. (2011) Clostridium difficile Colitis: Factors Associated with Outcome and Assessment of Mortality at a National Level. Journal of Gastrointestinal Surgery 15:9, 1548-1555
CrossRef48
Lynne V McFarland. (2011) Emerging therapies for Clostridium difficile infections. Expert Opinion on Emerging Drugs 16:3, 425-439
CrossRef49
Parakkal Deepak, Eli D. Ehrenpreis. (2011) Diarrhea. Disease-a-Month 57:9, 490-510
CrossRef50
Matthew D. Neal, John C. Alverdy, Daniel E. Hall, Richard L. Simmons, Brian S. Zuckerbraun. (2011) Diverting Loop Ileostomy and Colonic Lavage. Annals of Surgery 254:3, 423-429
CrossRef51
K. Weiss, R. Blais, A. Fortin, S. Lantin, M. Gaudet. (2011) Impact of a Multipronged Education Strategy on Antibiotic Prescribing in Quebec, Canada. Clinical Infectious Diseases 53:5, 433-439
CrossRef52
Daniel L. Raines, Fred A. Lopez. (2011) Clostridium Difficile Infection in Non–HIV-Immunocompromised Patients and in HIV-Infected Patients. Current Gastroenterology Reports 13:4, 344-350
CrossRef53
H. Pituch, P. Obuch-Woszczatynski, D. Wultanska, G. Nurzynska, C. Harmanus, A. Banaszkiewicz, A. Radzikowski, M. Luczak, A. van Belkum, E. Kuijper. (2011) Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004-2006. Journal of Medical Microbiology 60:8, 1200-1205
CrossRef54
C. Eckert, F. Vromman, A. Halkovich, F. Barbut. (2011) Multilocus variable-number tandem repeat analysis: a helpful tool for subtyping French Clostridium difficile PCR ribotype 027 isolates. Journal of Medical Microbiology 60:8, 1088-1094
CrossRef55
H. Kato, Y. Arakawa. (2011) Use of the loop-mediated isothermal amplification method for identification of PCR ribotype 027 Clostridium difficile. Journal of Medical Microbiology 60:8, 1126-1130
CrossRef56
S. Thean, B. Elliott, T. V. Riley. (2011) Clostridium difficile in horses in Australia - a preliminary study. Journal of Medical Microbiology 60:8, 1188-1192
CrossRef57
S. Tyler Phillips, Kristin Nagaro, Susan P. Sambol, Stuart Johnson, Dale N. Gerding. (2011) Susceptibility of hamsters to infection by historic and epidemic BI Clostridium difficile strains during daily administration of three fluoroquinolones. Anaerobe 17:4, 166-169
CrossRef58
J. Hemminger, J.-M. Balada-Llasat, M. Raczkowski, M. Buckosh, P. Pancholi. (2011) Two case reports of Clostridium difficile bacteremia, one with the epidemic NAP-1 strain. Infection 39:4, 371-373
CrossRef59
D.F. Florescu, C. Mindru, H.E. Chambers, A.C. Kalil. (2011) Clostridium difficile and cytomegalovirus colitis co-infection: search for the hidden ‘bug’. Transplant Infectious Disease 13:4, 411-415
CrossRef60
C. P. Kelly, L. Kyne. (2011) The host immune response to Clostridium difficile. Journal of Medical Microbiology 60:8, 1070-1079
CrossRef61
Abhishek Deshpande, Vinay Pasupuleti, Preethi Patel, Gati Ajani, Geraldine Hall, Bo Hu, Anil Jain, David D.K. Rolston. (2011) Repeat Stool Testing to Diagnose Clostridium difficile Infection Using Enzyme Immunoassay Does Not Increase Diagnostic Yield. Clinical Gastroenterology and Hepatology 9:8, 665-669.e1
CrossRef62
Melina Kachrimanidou, Nikolaos Malisiovas. (2011) Clostridium difficile Infection: A Comprehensive Review. Critical Reviews in Microbiology 37:3, 178-187
CrossRef63
Frédéric Barbut, Gabrielle Jones, Catherine Eckert. (2011) Epidemiology and control of Clostridium difficile infections in healthcare settings. Current Opinion in Infectious Diseases 24:4, 370-376
CrossRef64
Kathleen M Mullane, Sherwood Gorbach. (2011) Fidaxomicin: first-in-class macrocyclic antibiotic. Expert Review of Anti-infective Therapy 9:7, 767-777
CrossRef65
Maureen K. Bolon. (2011) The Newer Fluoroquinolones. Medical Clinics of North America 95:4, 793-817
CrossRef66
E. R. Dubberke, A. M. Butler, H. A. Nyazee, K. A. Reske, D. S. Yokoe, J. Mayer, J. E. Mangino, Y. M. Khan, V. J. Fraser, . (2011) The Impact of ICD-9-CM Code Rank Order on the Estimated Prevalence of Clostridium difficile Infections. Clinical Infectious Diseases 53:1, 20-25
CrossRef67
S. D. Baines, A. R. Noel, G. S. Huscroft, S. L. Todhunter, R. O'Connor, J. K. Hobbs, J. Freeman, A. M. Lovering, M. H. Wilcox. (2011) Evaluation of linezolid for the treatment of Clostridium difficile infection caused by epidemic strains using an in vitro human gut model. Journal of Antimicrobial Chemotherapy 66:7, 1537-1546
CrossRef68
Thomas J. Sandora, Monica Fung, Kathleen Flaherty, Laura Helsing, Patricia Scanlon, Gail Potter-Bynoe, Courtney A. Gidengil, Grace M. Lee. (2011) Epidemiology and Risk Factors for Clostridium difficile Infection in Children. The Pediatric Infectious Disease Journal 30:7, 580-584
CrossRef69
A. M. Kufelnicka, T. J. Kirn. (2011) Effective Utilization of Evolving Methods for the Laboratory Diagnosis of Clostridium difficile Infection. Clinical Infectious Diseases 52:12, 1451-1457
CrossRef70
Shilpa M. Patel, Evan Stashefsky, Marie-Claire Maroun, Leonard B. Johnson. (2011) The Impact of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in patients with Clostridium difficile infection. Medical Hypotheses 76:6, 813-815
CrossRef71
C. Eckert, V. Lalande, F. Barbut. (2011) Diagnostic des infections à Clostridium difficile. Journal des Anti-infectieux 13:2, 67-73
CrossRef72
H. Kissi, M. Seddik, D. Belloula, P. Coutarel, J. -F. Cadranel. (2011) Un cas d’infection à Clostridium difficile récidivante. Journal Africain d'Hépato-Gastroentérologie 5:2, 140-143
CrossRef73
Deirdre L. Church, Barbara L. Chow, Tracie Lloyd, Daniel B. Gregson. (2011) Evaluation of automated repetitive-sequence–based PCR (DiversiLab) compared to PCR ribotyping for rapid molecular typing of community- and nosocomial-acquired Clostridium difficile. Diagnostic Microbiology and Infectious Disease 70:2, 183-190
CrossRef74
F. Barbut, J.-L. Meynard, C. Eckert. (2011) Traitement des infections digestives à Clostridium difficile : anciennes et nouvelles approches. Journal des Anti-infectieux 13:2, 74-86
CrossRef75
H. J. Schultz, R. S. Edson. (2011) Cystitis Treatment in Women, Circa 2011: New Role for an Old Drug. Mayo Clinic Proceedings 86:6, 477-479
CrossRef76
Simon D. Goldenberg, Gary L. French. (2011) Lack of association of tcdC type and binary toxin status with disease severity and outcome in toxigenic Clostridium difficile. Journal of Infection 62:5, 355-362
CrossRef77
Matthias A. Oberli, Marie-Lyn Hecht, Pascal Bindschädler, Alexander Adibekian, Thomas Adam, Peter H. Seeberger. (2011) A Possible Oligosaccharide-Conjugate Vaccine Candidate for Clostridium difficile Is Antigenic and Immunogenic. Chemistry & Biology 18:5, 580-588
CrossRef78
B.A. Hickey, R. Robinson, A. Johansen, S.A. Jones. (2011) Single dose antibiotic prophylaxis for patients who undergo hip fracture surgery. Journal of Hospital Infection 78:1, 66-67
CrossRef79
Claire M.F. van Nispen tot Pannerden, Annelies Verbon, Ernst J. Kuipers. (2011) Recurrent Clostridium difficile Infection. Drugs 71:7, 853-868
CrossRef80
P. Vohra, I. R. Poxton. (2011) Comparison of toxin and spore production in clinically relevant strains of Clostridium difficile. Microbiology 157:5, 1343-1353
CrossRef81
Ashwin N. Ananthakrishnan, Emily L. McGinley, Kia Saeian, David G. Binion. (2011) Temporal trends in disease outcomes related to Clostridium difficile infection in patients with inflammatory bowel disease. Inflammatory Bowel Diseases 17:4, 976-983
CrossRef82
M. P. M. Hensgens, A. Goorhuis, C. M. J. Kinschot, M. J. T. Crobach, C. Harmanus, E. J. Kuijper. (2011) Clostridium difficile infection in an endemic setting in the Netherlands. European Journal of Clinical Microbiology & Infectious Diseases 30:4, 587-593
CrossRef83
H.A. White, M.J. Wiselka. (2011) Inpatient mortality and death reporting associated with Clostridium difficile infection in a large teaching hospital. Journal of Hospital Infection 77:4, 369-370
CrossRef84
Anilrudh A. Venugopal, Dale N. Gerding, Stuart Johnson. (2011) 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. American Journal of Infection Control 39:3, 206-211
CrossRef85
Camilla Wiuff, Derek J. Brown, Henry Mather, A-Lan Banks, Anne Eastaway, John E. Coia. (2011) The epidemiology of Clostridium difficile in Scotland. Journal of Infection 62:4, 271-279
CrossRef86
Shigeki Fujitani, W. Lance George, Margie A. Morgan, Stephen Nichols, A. Rekha Murthy. (2011) Implications for vancomycin-resistant Enterococcus colonization associated with Clostridium difficile infections. American Journal of Infection Control 39:3, 188-193
CrossRef87
Megan K. Shaughnessy, Renee L. Micielli, Daryl D. DePestel, Jennifer Arndt, Cathy L. Strachan, Kathy B. Welch, Carol E. Chenoweth. (2011) Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection. Infection Control and Hospital Epidemiology 32:3, 201-206
CrossRef88
Mamoon A. Aldeyab, Michael J. Devine, Peter Flanagan, Michael Mannion, Avril Craig, Michael G. Scott, Stephan Harbarth, Nathalie Vernaz, Elizabeth Davies, Jon S. Brazier, Brian Smyth, James C. McElnay, Brendan F. Gilmore, Geraldine Conlon, Fidelma A. Magee, Feras W. Darwish Elhajji, Shaunagh Small, Collette Edwards, Chris Funston, Mary P. Kearney. (2011) Multihospital Outbreak of Clostridium difficile Ribotype 027 Infection: Epidemiology and Analysis of Control Measures. Infection Control and Hospital Epidemiology 32:3, 210-219
CrossRef89
Shigeki Fujitani, W. Lance George, A. Rekha Murthy. (2011) Comparison of Clinical Severity Score Indices for Clostridium difficile Infection. Infection Control and Hospital Epidemiology 32:3, 220-228
CrossRef90
Susanna Naggie, Becky A. Miller, Kimberly B. Zuzak, Brian W. Pence, Ashley J. Mayo, Bradly P. Nicholson, Preeta K. Kutty, L. Clifford McDonald, Christopher W. Woods. (2011) A Case-control Study of Community-associated Clostridium difficile Infection: No Role for Proton Pump Inhibitors. The American Journal of Medicine 124:3, 276.e1-276.e7
CrossRef91
Brian G. Harbrecht, Glen A. Franklin, Robert M. Shirley, Jason W. Smith, Frank B. Miller, J. David Richardson. (2011) Statewide Experience with Clostridium difficile Colitis in Academic and Nonacademic Medical Centers *. Surgical Infections110306225234014
CrossRef92
Louie, Thomas J., Miller, Mark A., Mullane, Kathleen M., Weiss, Karl, Lentnek, Arnold, Golan, Yoav, Gorbach, Sherwood, Sears, Pamela, Shue, Youe-Kong, . (2011) Fidaxomicin versus Vancomycin for Clostridium difficile Infection. New England Journal of Medicine 364:5, 422-431
Full Text93
Sarah Hariri, Philippe Gouin, Jean-Jacques Tuech, Benoit Veber, Bertrand Dureuil. (2011) Clostridium difficile infection causing multiple organ failure and small-bowel enteritis. Clinics and Research in Hepatology and Gastroenterology 35:2, 142-144
CrossRef94
John R. Wingard, Jack Hsu, John W. Hiemenz. (2011) Hematopoietic Stem Cell Transplantation: An Overview of Infection Risks and Epidemiology. Hematology/Oncology Clinics of North America 25:1, 101-116
CrossRef95
Kelly Lesperance, Marlin Wayne Causey, Michael Spencer, Scott Russell Steele. (2011) The morbidity of Clostridium difficile infection after elective colonic resection—results from a national population database. The American Journal of Surgery 201:2, 141-148
CrossRef96
T. Pasanen, S. M. Kotila, J. Horsma, A. Virolainen, J. Jalava, S. Ibrahem, J. Antikainen, S. Mero, E. Tarkka, M. Vaara, P. Tissari. (2011) Comparison of repetitive extragenic palindromic sequence-based PCR with PCR ribotyping and pulsed-field gel electrophoresis in studying the clonality of Clostridium difficile. Clinical Microbiology and Infection 17:2, 166-175
CrossRef97
Ellie JC Goldstein. (2011) Beyond the target pathogen: ecological effects of the hospital formulary. Current Opinion in Infectious Diseases 24:Suppl 1, S21-S31
CrossRef98
E. R. Dubberke, D. B. Haslam, C. Lanzas, L. D. Bobo, C.-A. D. Burnham, Y. T. Gröhn, P. I. Tarr. (2011) The Ecology and Pathobiology of Clostridium difficile Infections: An Interdisciplinary Challenge. Zoonoses and Public Health 58:1, 4-20
CrossRef99
Lisa F Dawson, Elizabeth H Donahue, Stephen T Cartman, Richard H Barton, Jake Bundy, Ruth McNerney, Nigel P Minton, Brendan W Wren. (2011) The analysis of para-cresol production and tolerance in Clostridium difficile 027 and 012 strains. BMC Microbiology 11:1, 86
CrossRef100
David T. Rubin, Sunana Sohi, Matthew Glathar, Tojo Thomas, Nicole Yadron, Bonnie L. Surma. (2011) Rifaximin Is Effective for the Treatment of Clostridium difficile—Associated Diarrhea: Results of an Open-Label Pilot Study. Gastroenterology Research and Practice 2011, 1-5
CrossRef101
Teena Chopra, Pranatharthi Chandrasekar, Hossein Salimnia, Lance K. Heilbrun, Daryn Smith, George J. Alangaden. (2011) Recent epidemiology of Clostridium difficile infection during hematopoietic stem cell transplantation. Clinical Transplantation 25:1, E82-E87
CrossRef102
Brett Mitchell, Chris Ware, Alistair McGregor, Saffron Brown, Anne Wells. (2011) Clostridium difficile infection in Tasmanian public hospitals 2006 - 2010. Healthcare Infection 16:3, 101
CrossRef103
Jennifer A. Unger, Estella Whimbey, Michael G. Gravett, David A. Eschenbach. (2011) The Emergence of Clostridium difficile Infection among Peripartum Women: A Case-Control Study of a C. difficile Outbreak on an Obstetrical Service. Infectious Diseases in Obstetrics & Gynecology 2011, 1-8
CrossRef104
Judith R. Kelsen, Jason Kim, Dan Latta, Sarah Smathers, Karin L. McGowan, Theodore Zaoutis, Petar Mamula, Robert N. Baldassano. (2011) Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease. Inflammatory Bowel Diseases 17:1, 50-55
CrossRef105
Christopher A. Ohl, Vera P. Luther. (2011) Antimicrobial stewardship for inpatient facilities. Journal of Hospital Medicine 6:S1, S4-S15
CrossRef106
Caoilfhionn OʼDonoghue, Lorraine Kyne. (2011) Update on Clostridium difficile infection. Current Opinion in Gastroenterology 27:1, 38-47
CrossRef107
Martijn P Bauer, Daan W Notermans, Birgit HB van Benthem, Jon S Brazier, Mark H Wilcox, Maja Rupnik, Dominique L Monnet, Jaap T van Dissel, Ed J Kuijper. (2011) Clostridium difficile infection in Europe: a hospital-based survey. The Lancet 377:9759, 63-73
CrossRef108
Julian Parkhill, Brendan W Wren. (2011) Bacterial epidemiology and biology - lessons from genome sequencing. Genome Biology 12:10, 230
CrossRef109
Marwan S. Abougergi, John H. Kwon. (2011) Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review. Digestive Diseases and Sciences 56:1, 19-26
CrossRef110
M. A. Slavin, S. Lingaratnam, L. Mileshkin, D. L. Booth, M. J. Cain, D. S. Ritchie, A. Wei, K. A. Thursky. (2011) Use of antibacterial prophylaxis for patients with neutropenia. Internal Medicine Journal 41:1b, 102-109
CrossRef111
Ashwin N. Ananthakrishnan. (2011) Clostridium difficile infection: epidemiology, risk factors and management. Nature Reviews Gastroenterology & Hepatology 8:1, 17-26
CrossRef112
Genevieve McKew, Kate Clezy. (2011) Clinical features, management and infection control of Clostridium difficile infection in an Australian tertiary hospital: a prospective observational study. Healthcare Infection 16:4, 140
CrossRef113
Scott E. Kincaid. (2010) <i>Clostridium difficile</i>-Associated Disease: Impact of the Updated SHEA/IDSA Guidelines. The Consultant Pharmacist 25:12, 834-836
CrossRef114
J. Cooke, K. Alexander, E. Charani, K. Hand, T. Hills, P. Howard, C. Jamieson, W. Lawson, J. Richardson, P. Wade. (2010) Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. Journal of Antimicrobial Chemotherapy 65:12, 2669-2673
CrossRef115
Charles Venuto, Mary Butler, Elizabeth Dodds Ashley, Jack Brown. (2010) Alternative Therapies for Clostridium difficile Infections. Pharmacotherapy 30:12, 1266-1278
CrossRef116
Jaffar A. Al-Tawfiq, Mahmoud S. Abed. (2010) Clostridium difficile-associated disease among patients in Dhahran, Saudi Arabia. Travel Medicine and Infectious Disease 8:6, 373-376
CrossRef117
Satoshi Hori, Anup Sengupta, Alexis Joannides, Ben Balogun-Ojuri, Rebecca Tilley, John McLoughlin. (2010) Changing antibiotic prophylaxis for transrectal ultrasound-guided prostate biopsies: are we putting our patients at risk?. BJU International 106:9, 1298-1302
CrossRef118
Abhishek Deshpande, Vinay Pasupuleti, Chaitanya Pant, Geraldine Hall, Anil Jain. (2010) Potential value of repeat stool testing for Clostridium difficile stool toxin using enzyme immunoassay?. Current Medical Research and Opinion 26:11, 2635-2641
CrossRef119
Shailesh Jain, Robert L.J. Graham, Geoff McMullan, Nigel G. Ternan. (2010) Proteomic analysis of the insoluble subproteome of Clostridium difficile strain 630. FEMS Microbiology Letters 312:2, 151-159
CrossRef120
Bahman Saatian, Chandralekha Banerjee, Karen C. Carroll, Traci L. Ross, Farin Kamangar. (2010) Characterization of Clostridium difficile Infection and Analysis of Recovered Isolates in a Community Hospital Population in Baltimore, Maryland. Infectious Diseases in Clinical Practice 18:6, 383-388
CrossRef121
A. H. W. Bruns, J. J. Oosterheert, E. J. Kuijper, J. W. J. Lammers, S. Thijsen, A. Troelstra, A. I. M. Hoepelman. (2010) Impact of different empirical antibiotic treatment regimens for community-acquired pneumonia on the emergence of Clostridium difficile. Journal of Antimicrobial Chemotherapy 65:11, 2464-2471
CrossRef122
William Cheadle, James T. Lee, Lena M. Napolitano, Ronald Lee Nichols. (2010) Clinical Update on the Use of Moxifloxacin in the Treatment of Community-Acquired Complicated Intraabdominal Infections. Surgical Infections 11:5, 487-494
CrossRef123
Ashwin N Ananthakrishnan, David G Binion. (2010) Impact of Clostridium difficile on inflammatory bowel disease. Expert Review of Gastroenterology & Hepatology 4:5, 589-600
CrossRef124
Teena Chopra, George J Alangaden, Pranatharthi Chandrasekar. (2010) Clostridium difficile infection in cancer patients and hematopoietic stem cell transplant recipients. Expert Review of Anti-infective Therapy 8:10, 1113-1119
CrossRef125
Nicole Knight, Taylor Strait, Nicholas Anthony, Roger Lovell, H. James Norton, Robert Sautter, Martin Scobey. (2010) Clostridium difficile colitis: A retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy. American Journal of Infection Control 38:7, 523-528
CrossRef126
Peter Davey, Jacqueline Sneddon, Dilip Nathwani. (2010) Overview of strategies for overcoming the challenge of antimicrobial resistance. Expert Review of Clinical Pharmacology 3:5, 667-686
CrossRef127
J. Price, E. Cheek, S. Lippett, M. Cubbon, D. N. Gerding, S. P. Sambol, D. M. Citron, M. Llewelyn. (2010) Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis. Clinical Microbiology and Infection 16:8, 1297-1302
CrossRef128
Sahil Khanna, Darrell S Pardi. (2010) The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Review of Gastroenterology & Hepatology 4:4, 409-416
CrossRef129
Linda D. Bobo, Erik R. Dubberke. (2010) Recognition and prevention of hospital-associated enteric infections in the intensive care unit. Critical Care Medicine 38, S324-S334
CrossRef130
Andrew E. Simor. (2010) Diagnosis, Management, and Prevention of Clostridium difficile Infection in Long-Term Care Facilities: A Review. Journal of the American Geriatrics Society 58:8, 1556-1564
CrossRef131
Marianne Horgan, Orla O'Sullivan, Aidan Coffey, Gerald F. Fitzgerald, Douwe van Sinderen, Olivia McAuliffe, R. Paul Ross. (2010) Genome analysis of the Clostridium difficile phage ΦCD6356, a temperate phage of the Siphoviridae family. Gene 462:1-2, 34-43
CrossRef132
J. S. WEESE, R. FINLEY, R. R. REID-SMITH, N. JANECKO, J. ROUSSEAU. (2010) Evaluation of Clostridium difficile in dogs and the household environment. Epidemiology and Infection 138:08, 1100-1104
CrossRef133
S. Naggie, J. Frederick, B. C. Pien, B. A. Miller, D. T. Provenzale, K. C. Goldberg, C. W. Woods. (2010) Community-associated Clostridium difficile infection: experience of a veteran affairs medical center in southeastern USA. Infection 38:4, 297-300
CrossRef134
Enrico Selva, Giancarlo Lancini. 2010. Rifamycins, Antibacterial Antibiotics and Their New Applications. , 173-187.
CrossRef135
J.A. Karas, D.A. Enoch, S.H. Aliyu. (2010) A review of mortality due to Clostridium difficile infection. Journal of Infection 61:1, 1-8
CrossRef136
Simon D. Goldenberg, Thomas Dieringer, Gary L. French. (2010) Detection of toxigenic Clostridium difficile in diarrheal stools by rapid real-time polymerase chain reaction. Diagnostic Microbiology and Infectious Disease 67:3, 304-307
CrossRef137
Parag Butala, Celia M. Divino. (2010) Surgical aspects of fulminant Clostridium difficile Colitis. The American Journal of Surgery 200:1, 131-135
CrossRef138
John R. Wingard, Jack Hsu, John W. Hiemenz. (2010) Hematopoietic Stem Cell Transplantation: An Overview of Infection Risks and Epidemiology. Infectious Disease Clinics of North America 24:2, 257-272
CrossRef139
James Gasperino, Maya Garala, Hillel W. Cohen, Vladimir Kvetan, Brian Currie. (2010) Investigation of critical care unit utilization and mortality in patients infected with Clostridium difficile. Journal of Critical Care 25:2, 282-286
CrossRef140
Michael B. Rothberg, Penelope S. Pekow, Maureen Lahti, Oren Brody, Daniel J. Skiest, Peter K. Lindenauer. (2010) Comparative effectiveness of macrolides and quinolones for patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Journal of Hospital Medicine 5:5, 261-267
CrossRef141
Naomi G Diggs, Christina M Surawicz. (2010) Clostridium difficile infection: still principally a disease of the elderly. Therapy 7:3, 295-301
CrossRef142
Hans H. Liu. (2010) Safety Profile of the Fluoroquinolones. Drug Safety 33:5, 353-369
CrossRef143
M. He, M. Sebaihia, T. D. Lawley, R. A. Stabler, L. F. Dawson, M. J. Martin, K. E. Holt, H. M. B. Seth-Smith, M. A. Quail, R. Rance, K. Brooks, C. Churcher, D. Harris, S. D. Bentley, C. Burrows, L. Clark, C. Corton, V. Murray, G. Rose, S. Thurston, A. van Tonder, D. Walker, B. W. Wren, G. Dougan, J. Parkhill. (2010) Evolutionary dynamics of Clostridium difficile over short and long time scales. Proceedings of the National Academy of Sciences 107:16, 7527-7532
CrossRef144
(2010) Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. New England Journal of Medicine 362:15, 1444-1446
Full Text145
J.S. Weese, R.J. Reid-Smith, B.P. Avery, J. Rousseau. (2010) Detection and characterization of Clostridium difficile in retail chicken. Letters in Applied Microbiology 50:4, 362-365
CrossRef146
Ian R Poxton. (2010) Fidaxomicin: a new macrocyclic, RNA polymerase-inhibiting antibiotic for the treatment of Clostridium difficile infections. Future Microbiology 5:4, 539-548
CrossRef147
Andrew Walkty, David A. Boyd, Denise Gravel, Jim Hutchinson, Allison McGeer, Dorothy Moore, Andrew Simor, Kathryn Suh, Geoff Taylor, Mark Miller, Michael R. Mulvey. (2010) Molecular characterization of moxifloxacin resistance from Canadian Clostridium difficile clinical isolates. Diagnostic Microbiology and Infectious Disease 66:4, 419-424
CrossRef148
Rosemarie Metzger, Brian R. Swenson, Hugo Bonatti, Traci L. Hedrick, Tjasa Hranjec, Kimberley A. Popovsky, Timothy L. Pruett, Robert G. Sawyer. (2010) Identification of Risk Factors for the Development of Clostridium difficile-Associated Diarrhea Following Treatment of Polymicrobial Surgical Infections. Annals of Surgery 251:4, 722-727
CrossRef149
Scott Curry. (2010) Clostridium difficile. Clinics in Laboratory Medicine 30:1, 329-342
CrossRef150
M. Jöbstl, S. Heuberger, A. Indra, R. Nepf, J. Köfer, M. Wagner. (2010) Clostridium difficile in raw products of animal origin. International Journal of Food Microbiology 138:1-2, 172-175
CrossRef151
Jaime O. Herrera-Cáceres, Adrián Camacho-Ortiz, Arturo Galindo-Fraga, Melissa Hernández-Durán, Andrea Cordero-Rangel, Araceli Hernández-Cruz, Miriam Bobadilla-del Valle, Alfredo Ponce-de-León, José Sifuentes-Osornio. (2010) Concordance Between Two Enzyme Immunoassays for the Detection of Clostridium difficile Toxins. Archives of Medical Research 41:2, 92-96
CrossRef152
Haig Dudukgian, Ester Sie, Claudia Gonzalez-Ruiz, David A. Etzioni, Andreas M. Kaiser. (2010) C. difficile Colitis—Predictors of Fatal Outcome. Journal of Gastrointestinal Surgery 14:2, 315-322
CrossRef153
A. Kola. (2010) Clostridium-difficile-Infektionen. Der Internist 51:2, 154-160
CrossRef154
Cristina Lanzas, Patrick Ayscue, Renata Ivanek, Yrjö T. Gröhn. (2010) Model or meal? Farm animal populations as models for infectious diseases of humans. Nature Reviews Microbiology
CrossRef155
Lowy, Israel, Molrine, Deborah C., Leav, Brett A., Blair, Barbra M., Baxter, Roger, Gerding, Dale N., Nichol, Geoffrey, Thomas, William D. Jr., Leney, Mark, Sloan, Susan, Hay, Catherine A., Ambrosino, Donna M., . (2010) Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. New England Journal of Medicine 362:3, 197-205
Full Text156
, , . (2010) Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections. Infection and Chemotherapy 42:6, 323
CrossRef157
J. S. Weese. (2010) Clostridium difficile in foodâinnocent bystander or serious threat?. Clinical Microbiology and Infection 16:1, 3-10
CrossRef158
Brett A. Leav, Barbra Blair, Mark Leney, Michael Knauber, Courtney Reilly, Israel Lowy, Dale N. Gerding, Ciarán P. Kelly, Kia Katchar, Roger Baxter, Donna Ambrosino, Deborah Molrine. (2010) Serum anti-toxin B antibody correlates with protection from recurrent Clostridium difficile infection (CDI). Vaccine 28:4, 965-969
CrossRef159
Guadalupe Garcia-Tsao, Christina M Surawicz. (2010) Editorial: Clostridium difficile Infection: Yet Another Predictor of Poor Outcome in Cirrhosis. The American Journal of Gastroenterology 105:1, 114-116
CrossRef160
Yune Jeong Lee, Myung Gyu Choi, Chul Hyun Lim, Woong Ryong Jung, Hyun Sun Cho, Hye Young Sung, Kwan Woo Nam, Jae Hyuck Chang, Yu Kyung Cho, Jae Myung Park, Sang Woo Kim, In Sik Chung. (2010) Change of Clostridium difficile Colitis during Recent 10 Years in Korea. The Korean Journal of Gastroenterology 55:3, 169
CrossRef161
So Hee Lee, Heung Woo Park, Sae Hoon Kim, Yoon Seok Chang, Sun Sin Kim, Sang Heon Cho, Kyung Up Min, You Young Kim. (2010) The Current Practice of Skin Testing for Antibiotics in Korean Hospitals. The Korean Journal of Internal Medicine 25:2, 207
CrossRef162
Thomas V. Riley. (2010) From obscurity to 'superbug' – The rise of Clostridium difficile. Healthcare Infection 15:3, 59
CrossRef163
Marwan S. Abougergi, Apoorv Broor, Wei Cui, Bernard G. Jaar. (2010) Intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis: An observational study and review of the literature. Journal of Hospital Medicine 5:1, E1-E9
CrossRef164
Ashwin N. Ananthakrishnan, Mazen Issa, David G. Binion. (2010) Clostridium Difficile and Inflammatory Bowel Disease. Medical Clinics of North America 94:1, 135-153
CrossRef165
Hania Szajewska, Piotr Dziechciarz. (2010) Gastrointestinal infections in the pediatric population. Current Opinion in Gastroenterology 26:1, 36-44
CrossRef166
Jin Ho Lee, Su-Yeon Lee, You Sun Kim, Sun-Wook Park, Sung Won Park, So Young Jo, Soo Hyung Ryu, Jung Hwan Lee, Jeong Seop Moon, Dong Hee Whang, Bo Moon Shin. (2010) The Incidence and Clinical Features of Clostridium difficile Infection; Single Center Study. The Korean Journal of Gastroenterology 55:3, 175
CrossRef167
Brandon P. Verdoorn, Robert Orenstein, Jon E. Rosenblatt, Lynne M. Sloan, Cathy D. Schleck, William S. Harmsen, Lisa M. Nyre, Robin Patel. (2010) High prevalence of tcdC deletion-carrying Clostridium difficile and lack of association with disease severity. Diagnostic Microbiology and Infectious Disease 66:1, 24-28
CrossRef168
L. Guay, Y. Poulin, L. Valiquette, G. Schmutz, O. Lesur. 2010. Colites infectieuses aiguës en réanimation. , 247-265.
CrossRef169
Maureen K. Bolon. (2009) The Newer Fluoroquinolones. Infectious Disease Clinics of North America 23:4, 1027-1051
CrossRef170
Fatemeh Rafii, Miseon Park, Gonçalo Gamboa da Costa, Luisa Camacho. (2009) Comparison of the metabolic activities of four wild-type Clostridium perfringens strains with their gatifloxacin-selected resistant mutants. Archives of Microbiology 191:12, 895-902
CrossRef171
Lisa F. Dawson, Esmeralda Valiente, Brendan W. Wren. (2009) Clostridium difficile—A continually evolving and problematic pathogen. Infection, Genetics and Evolution 9:6, 1410-1417
CrossRef172
Ashwin N. Ananthakrishnan, Mazen Issa, David G. Binion. (2009) Clostridium Difficile and Inflammatory Bowel Disease. Gastroenterology Clinics of North America 38:4, 711-728
CrossRef173
E. R. Dubberke, D. J. Riddle, . (2009) Clostridium difficile in Solid Organ Transplant Recipients. American Journal of Transplantation 9, S35-S40
CrossRef174
Natasha Bagdasarian, Curtis D Collins, Preeti N Malani. (2009) Treatment of Clostridium difficile infection in older adults. Aging Health 5:6, 753-761
CrossRef175
Martijn P Bauer, Jaap T van Dissel, Ed J Kuijper. (2009) Clostridium difficile: controversies and approaches to management. Current Opinion in Infectious Diseases 22:6, 517-524
CrossRef176
John O’Horo, Nasia Safdar. (2009) The role of immunoglobulin for the treatment of Clostridium difficile infection: a systematic review. International Journal of Infectious Diseases 13:6, 663-667
CrossRef177
(2009) References. Bone Marrow Transplantation 44:8, 537-557
CrossRef178
Miguel Salazar, Kevin W. Garey, Zhi-Dong Jiang, Thanh Dao-Tran, Herbert DuPont. (2009) Changing Clostridium difficile infection testing and treatment trends at a large tertiary care teaching hospital. Pharmacy World & Science 31:5, 565-571
CrossRef179
Naomi G. Diggs, Christina M. Surawicz. (2009) Evolving concepts in Clostridium difficile colitis. Current Gastroenterology Reports 11:5, 400-405
CrossRef180
Marcie Tomblyn, Tom Chiller, Hermann Einsele, Ronald Gress, Kent Sepkowitz, Jan Storek, John R. Wingard, Jo-Anne H. Young, Michael A. Boeckh. (2009) Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global Perspective. Biology of Blood and Marrow Transplantation 15:10, 1143-1238
CrossRef181
Kenneth V. I. Rolston. (2009) New antimicrobial agents for the treatment of bacterial infections in cancer patients. Hematological Oncology 27:3, 107-114
CrossRef182
Newton G. Osborne, Balwant Ahluwalia. (2009) Pseudomembranous Colitis. Journal of Gynecologic Surgery 25:3, 129-131
CrossRef183
Kenneth V. I. Rolston. (2009) The Use of New and Better Antibiotics for Bacterial Infections in Patients With Leukemia. Clinical Lymphoma, Myeloma & Leukemia 9:0, S357-S363
CrossRef184
David J. Riddle, Erik R. Dubberke. (2009) Clostridium difficile Infection in the Intensive Care Unit. Infectious Disease Clinics of North America 23:3, 727-743
CrossRef185
O. M. Williams, R. C. Spencer. (2009) The management of Clostridium difficile infection. British Medical Bulletin 91:1, 87-110
CrossRef186
Marya D. Zilberberg, Andrew F. Shorr, Scott T. Micek, Joshua A. Doherty, Marin H. Kollef. (2009) Clostridium difficile-associated disease and mortality among the elderly critically ill. Critical Care Medicine 37:9, 2583-2589
CrossRef187
D. Wolff, T. Brüning, A. Gerritzen. (2009) Rapid detection of the Clostridium difficile ribotype 027 tcdC gene frame shift mutation at position 117 by real-time PCR and melt curve analysis. European Journal of Clinical Microbiology & Infectious Diseases 28:8, 959-962
CrossRef188
Y. Yadav, K.W. Garey, T.K. Dao-Tran, V. Kaila, K.Y.E. Gbito, H.L. DuPont. (2009) Automated system to identify Clostridium difficile infection among hospitalised patients. Journal of Hospital Infection 72:4, 337-341
CrossRef189
JENNI ANTIKAINEN, TANJA PASANEN, SOINTU MERO, EVELIINA TARKKA, JUHA KIRVESKARI, SAARA KOTILA, SILJA MENTULA, EIJA KÖNÖNEN, ANNI-RIITTA VIROLAINEN-JULKUNEN, MARTTI VAARA, PÄIVI TISSARI. (2009) Detection of virulence genes of Clostridium difficile by multiplex PCR. APMIS 117:8, 607-613
CrossRef190
Jeffrey Cloud, Laura Noddin, Amanda Pressman, Mary Hu, Ciaran Kelly. (2009) Clostridium difficile Strain NAP-1 Is Not Associated With Severe Disease in a Nonepidemic Setting. Clinical Gastroenterology and Hepatology 7:8, 868-873.e2
CrossRef191
Cassandra D. Salgado, Patrick D. Mauldin, Pamela J. Fogle, John A. Bosso. (2009) Analysis of an outbreak of Clostridium difficile infection controlled with enhanced infection control measures. American Journal of Infection Control 37:6, 458-464
CrossRef192
Maja Rupnik, Mark H. Wilcox, Dale N. Gerding. (2009) Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nature Reviews Microbiology 7:7, 526-536
CrossRef193
Michael J. Krier, George Triadafilopoulos. (2009) Management of Severe Clostridium difficile-Associated Diarrhea. Digestive Diseases and Sciences 54:6, 1199-1202
CrossRef194
Jennifer R. O'Connor, Stuart Johnson, Dale N. Gerding. (2009) Clostridium difficile Infection Caused by the Epidemic BI/NAP1/027 Strain. Gastroenterology 136:6, 1913-1924
CrossRef195
Alejandro Arteaga, Patricia Santa-Olalla, M. José Sierra, Aurora Limia, Marta Cortés, Carmen Amela. (2009) Riesgo epidémico de la enfermedad asociada a una nueva cepa de Clostridium difficile. Enfermedades Infecciosas y Microbiología Clínica 27:5, 278-284
CrossRef196
Dale N. Gerding, Colin Broom, Steven P. Gelone. (2009) Clostridium difficile Infection. Infectious Diseases in Clinical Practice 17:3, 161-168
CrossRef197
S. B. Debast, N. Vaessen, A. Choudry, E. A. J. Wiegers-Ligtvoet, R. J. van den Berg, E. J. Kuijper. (2009) Successful combat of an outbreak due to Clostridium difficile PCR ribotype 027 and recognition of specific risk factors. Clinical Microbiology and Infection 15:5, 427-434
CrossRef198
Daniel A. Leffler, J. Thomas Lamont. (2009) Treatment of Clostridium difficile-Associated Disease. Gastroenterology 136:6, 1899-1912
CrossRef199
Lori R. Holtz, Marguerite A. Neill, Phillip I. Tarr. (2009) Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages. Gastroenterology 136:6, 1887-1898
CrossRef200
Philip Toltzis, Jason Kim, Michael Dul, Joan Zoltanski, Sarah Smathers, Theoklis Zaoutis. (2009) Presence of the Epidemic North American Pulsed Field Type 1 Clostridium Difficile Strain in Hospitalized Children. The Journal of Pediatrics 154:4, 607-608
CrossRef201
Haihui Huang, Shi Wu, Minggui Wang, Yingyuan Zhang, Hong Fang, Ann-Chatrin Palmgren, Andrej Weintraub, Carl Erik Nord. (2009) Clostridium difficile infections in a Shanghai hospital: antimicrobial resistance, toxin profiles and ribotypes. International Journal of Antimicrobial Agents 33:4, 339-342
CrossRef202
Philip A. Efron, John E. Mazuski. (2009) Clostridium difficile Colitis. Surgical Clinics of North America 89:2, 483-500
CrossRef203
Mary Y. Hu, Kianoosh Katchar, Lorraine Kyne, Seema Maroo, Sanjeev Tummala, Valley Dreisbach, Hua Xu, Daniel A. Leffler, Ciarán P. Kelly. (2009) Prospective Derivation and Validation of a Clinical Prediction Rule for Recurrent Clostridium difficile Infection. Gastroenterology 136:4, 1206-1214
CrossRef204
Eric D. Cober, Preeti N. Malani. (2009) Clostridium Difficile Infection in the âOldestâ Old: Clinical Outcomes in Patients Aged 80 and Older. Journal of the American Geriatrics Society 57:4, 659-662
CrossRef205
Gareth C Parkes, Jeremy D Sanderson, Kevin Whelan. (2009) The mechanisms and efficacy of probiotics in the prevention of Clostridium difficile-associated diarrhoea. The Lancet Infectious Diseases 9:4, 237-244
CrossRef206
Jacqueline Janka, Naomi P OʼGrady. (2009) Clostridium difficile infection: current perspectives. Current Opinion in Critical Care 15:2, 149-153
CrossRef207
U. A. Ochsner, S. J. Bell, A. L. O'Leary, T. Hoang, K. C. Stone, C. L. Young, I. A. Critchley, N. Janjic. (2009) Inhibitory effect of REP3123 on toxin and spore formation in Clostridium difficile, and in vivo efficacy in a hamster gastrointestinal infection model. Journal of Antimicrobial Chemotherapy 63:5, 964-971
CrossRef208
B. R. DALTON, T. LYE-MACCANNELL, E. A. HENDERSON, D. R. MACCANNELL, T. J. LOUIE. (2009) Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting. Alimentary Pharmacology & Therapeutics 29:6, 626-634
CrossRef209
Dale N. Gerding. (2009) Clostridium difficile 30 years on: what has, or has not, changed and why?. International Journal of Antimicrobial Agents 33, S2-S8
CrossRef210
D. GUJJA, F. K. FRIEDENBERG. (2009) Predictors of serious complications due to Clostridium difficile infection. Alimentary Pharmacology & Therapeutics 29:6, 635-642
CrossRef211
M Sandra Dial. (2009) Proton Pump Inhibitor Use and Enteric Infections. The American Journal of Gastroenterology 104, S10-S16
CrossRef212
Karl Weiss. (2009) Clostridium difficile and fluoroquinolones: is there a link?. International Journal of Antimicrobial Agents 33, S29-S32
CrossRef213
N. Salles. (2009) Clostridium difficile: prévalence, conséquences et traitement chez la personne âgée. Les cahiers de l'année gérontologique 1:1, 73-79
CrossRef214
C. Denève, C. Janoir, I. Poilane, C. Fantinato, A. Collignon. (2009) New trends in Clostridium difficile virulence and pathogenesis. International Journal of Antimicrobial Agents 33, S24-S28
CrossRef215
Kevin P. High, Suzanne F. Bradley, Stefan Gravenstein, David R. Mehr, Vincent J. Quagliarello, Chesley Richards, Thomas T. Yoshikawa. (2009) Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of America. Journal of the American Geriatrics Society 57:3, 375-394
CrossRef216
Christopher W. Seder, Mario R. Villalba, James Robbins, Felicia A. Ivascu, Christopher F. Carpenter, Mary Dietrich, Mario R. Villalba. (2009) Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience. The American Journal of Surgery 197:3, 302-307
CrossRef217
Jacques Pepin, Thanh Truc Vo, Marylise Boutros, Eric Marcotte, Sandra Dial, Serge Dubé, Carol-Ann Vasilevsky, Nathalie McFadden, Carlos Patino, Annie-Claude Labbé. (2009) Risk Factors for Mortality Following Emergency Colectomy for Fulminant Clostridium difficile Infection. Diseases of the Colon & Rectum 52:3, 400-405
CrossRef218
Robert P. Fagan, David Albesa-Jové, Omar Qazi, Dmitri I. Svergun, Katherine A. Brown, Neil F. Fairweather. (2009) Structural insights into the molecular organization of the S-layer from Clostridium difficile. Molecular Microbiology 71:5, 1308-1322
CrossRef219
Daniel M. Musher, Nancy Logan, Adam M. Bressler, David P. Johnson, Jean‐François Rossignol. (2009) Nitazoxanide versus Vancomycin in Clostridium difficile Infection: A Randomized, Double‐Blind Study. Clinical Infectious Diseases 48:4, e41-e46
CrossRef220
Scott R. Curry, Jane W. Marsh, Kathleen A. Shutt, Carlene A. Muto, Mary M. O’Leary, Melissa I. Saul, A. William Pasculle, Lee H. Harrison. (2009) High Frequency of Rifampin Resistance Identified in an Epidemic Clostridium difficile Clone from a Large Teaching Hospital. Clinical Infectious Diseases 48:4, 425-429
CrossRef221
Christine Schlenker, Christina M. Surawicz. (2009) Emerging infections of the gastrointestinal tract. Best Practice & Research Clinical Gastroenterology 23:1, 89-99
CrossRef222
Donald M. Dumford, Michelle M. Nerandzic, Brittany C. Eckstein, Curtis J. Donskey. (2009) What is on that keyboard? Detecting hidden environmental reservoirs of Clostridium difficile during an outbreak associated with North American pulsed-field gel electrophoresis type 1 strains. American Journal of Infection Control 37:1, 15-19
CrossRef223
Karl Weiss, Annie Boisvert, Miguel Chagnon, Caroline Duchesne, Sylvie Habash, Yves Lepage, Julie Letourneau, Johanna Raty, Michel Savoie. (2009) Multipronged Intervention Strategy to Control an Outbreak of Clostridium difficile Infection (CDI) and Its Impact on the Rates of CDI from 2002 to 2007. Infection Control and Hospital Epidemiology 30:2, 156-162
CrossRef224
R. V. FENGER, A. LINNEBERG, M. TVEDE, C. ØSTERGAARD. (2009) Increasing seroprevalence of Clostridium difficile in an adult Danish general population. Epidemiology and Infection 137:02, 278
CrossRef225
Rupali K. Doshi, Gopi Patel, Richard MacKay, Frances Wallach. (2009) Healthcare-associated Infections: Epidemiology, Prevention, and Therapy. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 76:1, 84-94
CrossRef226
Kevin P. High, Suzanne F. Bradley, Stefan Gravenstein, David R. Mehr, Vincent J. Quagliarello, Chesley Richards, Thomas T. Yoshikawa. (2009) Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long‐Term Care Facilities: 2008 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 48:2, 149-171
CrossRef227
Luis Bujanda, Ángel Cosme. (2009) Diarrea asociada a Clostridium difficile. Gastroenterología y Hepatología 32:1, 48-56
CrossRef228
Erik R. Dubberke, Albert I. Wertheimer. (2009) Review of Current Literature on the Economic Burden of Clostridium difficile Infection • . Infection Control and Hospital Epidemiology 30:1, 57-66
CrossRef229
ROBERT E. PETRAS, WENDY L. FRANKEL. 2009. Large Intestine (Colon). , 755-836.
CrossRef230
Tae Jun Byun, Dong Soo Han, Sang Bong Ahn, Hyun Seok Cho, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Joo Hyun Sohn, Jung Oak Kang. (2009) Clinical Characteristics and Changing Epidemiology of Clostridium difficile-Associated Disease (CDAD). The Korean Journal of Gastroenterology 54:1, 13
CrossRef231
Haihui Huang, Carl Erik Nord. (2009) Can metronidazole still be used for treatment of Clostridium difficile infections?. Current Infectious Disease Reports 11:1, 3-6
CrossRef232
Lynne V McFarland. (2009) Renewed interest in a difficult disease: Clostridium difficile infections – epidemiology and current treatment strategies. Current Opinion in Gastroenterology 25:1, 24-35
CrossRef233
Helen Van Gessel, Thomas Riley, Alistair McGregor. (2009) Clostridium difficile infection: an update for infection control practitioners. Healthcare Infection 14:3, 115
CrossRef234
Karl Weiss. (2009) Toxin-binding treatment for Clostridium difficile: a review including reports of studies with tolevamer. International Journal of Antimicrobial Agents 33:1, 4-7
CrossRef235
Dimitrios P. Kontoyiannis, Russell E. Lewis, Kieren Marr. (2009) The Burden of Bacterial and Viral Infections in Hematopoietic Stem Cell Transplant. Biology of Blood and Marrow Transplantation 15:1, 128-133
CrossRef236
Hye Sun Park, Dong Soo Han. (2009) Management of Antibiotics-Associated Diarrhea. The Korean Journal of Gastroenterology 54:1, 5
CrossRef237
M. Raffat Jaber, Snorri Olafsson, Wesley L. Fung, Mark E. Reeves. (2008) Clinical Review of the Management of Fulminant Clostridium difficile Infection. The American Journal of Gastroenterology 103:12, 3195-3203
CrossRef238
Jaime Belmares, Dale N Gerding, Glenn Tillotson, Stuart Johnson. (2008) Measuring the severity of Clostridium difficile infection: implications for management and drug development. Expert Review of Anti-infective Therapy 6:6, 897-908
CrossRef239
Chin Wee Ang, Graham Heyes, Paul Morrison, Bryan Carr. (2008) The acquisition and outcome of ICU-acquired Clostridium difficile infection in a single centre in the UK. Journal of Infection 57:6, 435-440
CrossRef240
Andrea Endimiani, Federico Perez, Robert A Bonomo. (2008) Cefepime: a reappraisal in an era of increasing antimicrobial resistance. Expert Review of Anti-infective Therapy 6:6, 805-824
CrossRef241
Mary Y. Hu, Seema Maroo, Lorraine Kyne, Jeffrey Cloud, Sanjeev Tummala, Kianoosh Katchar, Valley Dreisbach, Laura Noddin, Ciarán P. Kelly. (2008) A Prospective Study of Risk Factors and Historical Trends in Metronidazole Failure for Clostridium difficile Infection. Clinical Gastroenterology and Hepatology 6:12, 1354-1360
CrossRef242
D Bobak, L M Arfons, R J Creger, H M Lazarus. (2008) Clostridium difficile-associated disease in human stem cell transplant recipients: coming epidemic or false alarm?. Bone Marrow Transplantation 42:11, 705-713
CrossRef243
David J Riddle, Erik R Dubberke. (2008) Clostridium difficile infection in solid organ transplant recipients. Current Opinion in Organ Transplantation 13:6, 592-600
CrossRef244
J. M. Blondeau. (2008) What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea?. Journal of Antimicrobial Chemotherapy 63:2, 238-242
CrossRef245
S. Persson, M. Torpdahl, K. E. P. Olsen. (2008) New multiplex PCR method for the detection of Clostridium difficile toxin A ( tcdA ) and toxin B ( tcdB ) and the binary toxin ( cdtA / cdtB ) genes applied to a Danish strain collection. Clinical Microbiology and Infection 14:11, 1057-1064
CrossRef246
Joseph Guiles, Ian Critchley, Xicheng Sun. (2008) New agents for Clostridium difficile -associated disease. Expert Opinion on Investigational Drugs 17:11, 1671-1683
CrossRef247
Abraham Goorhuis, Dennis Bakker, Jeroen Corver, Sylvia B. Debast, Celine Harmanus, Daan W. Notermans, Aldert A. Bergwerff, Frido W. Dekker, Ed J. Kuijper. (2008) Emergence of Clostridium difficile Infection Due to a New Hypervirulent Strain, Polymerase Chain Reaction Ribotype 078. Clinical Infectious Diseases 47:9, 1162-1170
CrossRef248
Iris Velazquez-Gomez, Rene Rocha-Rodriguez, Doris H. Toro, Jose J. Gutierrez-Nuñez, Glenda Gonzalez, Sonia Saavedra. (2008) A Severity Score Index for Clostridium difficile Infection. Infectious Diseases in Clinical Practice 16:6, 376-378
CrossRef249
Ralph H. Saunders. (2008) Could Clostridium difficile delay dental treatment for geriatric patients?. Special Care in Dentistry 28:6, 223-223
CrossRef250
Kelly, Ciarán P., LaMont, J. Thomas, . (2008) Clostridium difficile — More Difficult Than Ever. New England Journal of Medicine 359:18, 1932-1940
Full Text251
K.W. Garey, T.K. Dao-Tran, Z.D. Jiang, M.P. Price, L.O. Gentry, H.L. DuPont. (2008) A clinical risk index for Clostridium difficile infection in hospitalised patients receiving broad-spectrum antibiotics. Journal of Hospital Infection 70:2, 142-147
CrossRef252
Mazen Issa, Ashwin N. Ananthakrishnan, David G. Binion. (2008) Clostridium difficile and inflammatory bowel disease. Inflammatory Bowel Diseases 14:10, 1432-1442
CrossRef253
MARY C. VRTIS. (2008) Clostridium difficile. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 26:9, 563-569
CrossRef254
Lynne V McFarland. (2008) Antibiotic-associated diarrhea: epidemiology, trends and treatment. Future Microbiology 3:5, 563-578
CrossRef255
Erik R. Dubberke, Dale N. Gerding, David Classen, Kathleen M. Arias, Kelly Podgorny, Deverick J. Anderson, Helen Burstin, David P. Calfee, Susan E. Coffin, Victoria Fraser, Frances A. Griffin, Peter Gross, Keith S. Kaye, Michael Klompas, Evelyn Lo, Jonas Marschall, Leonard A. Mermel, Lindsay Nicolle, David A. Pegues, Trish M. Perl, Sanjay Saint, Cassandra D. Salgado, Robert A. Weinstein, Robert Wise, Deborah S. Yokoe. (2008) Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals • . Infection Control and Hospital Epidemiology 29:S1, S81-S92
CrossRef256
Kimberly Lumpkins, Grant V. Bochicchio, Manjari Joshi, Ryan Gens, Kelly Bochicchio, Anne Conway, Stacey Schaub, Thomas Scalea. (2008) Clostridium difficile Infection in Critically Injured Trauma Patients. Surgical Infections 9:5, 497-501
CrossRef257
Mar Sánchez‐Somolinos, Luis Alcalá, Teresa Peláez, Mercedes Marín, Adoración Martín, Pilar Catalán, Emilio Bouza. (2008) High Levels of Resistance to Fluoroquinolones among Clostridium difficile Isolates in a Spanish Hospital. Clinical Infectious Diseases 47:6, 818-822
CrossRef258
B. KLARIN, M. WULLT, I. PALMQUIST, G. MOLIN, A. LARSSON, B. JEPPSSON. (2008) Lactobacillus plantarum 299v reduces colonisation of Clostridium difficile in critically ill patients treated with antibiotics. Acta Anaesthesiologica Scandinavica 52:8, 1096-1102
CrossRef259
P. A. Sutton, S. Li, J. Webb, K. Solomon, J. Brazier, Y. R. Mahida. (2008) Essential role of toxin A in C. difficile 027 and reference strain supernatant-mediated disruption of Caco-2 intestinal epithelial barrier function. Clinical & Experimental Immunology 153:3, 439-447
CrossRef260
R. Cunningham, S. Dial. (2008) Is over-use of proton pump inhibitors fuelling the current epidemic of Clostridium difficile-associated diarrhoea?. Journal of Hospital Infection 70:1, 1-6
CrossRef261
Jason F. Hall, David Berger. (2008) Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. The American Journal of Surgery 196:3, 384-388
CrossRef262
R.-P. Vonberg, C. Reichardt, M. Behnke, F. Schwab, S. Zindler, P. Gastmeier. (2008) Costs of nosocomial Clostridium difficile-associated diarrhoea. Journal of Hospital Infection 70:1, 15-20
CrossRef263
John M. Boyce, Nancy L. Havill, Jonathan A. Otter, L. Clifford McDonald, Nicholas M. T. Adams, Timothea Cooper, Angela Thompson, Lois Wiggs, George Killgore, Allison Tauman, Judith Noble-Wang. (2008) Impact of Hydrogen Peroxide Vapor Room Decontamination on Clostridium difficile Environmental Contamination and Transmission in a Healthcare Setting. Infection Control and Hospital Epidemiology 29:8, 723-729
CrossRef264
R. RICCIARDI, K. HARRIMAN, N. N. BAXTER, L. K. HARTMAN, R. J. TOWN, B. A. VIRNIG. (2008) Predictors of Clostridium difficile colitis infections in hospitals. Epidemiology and Infection 136:07,
CrossRef265
Ed J. Kuijper, Mark H. Wilcox. (2008) Editorial Commentary: Decreased Effectiveness of Metronidazole for the Treatment of Clostridium difficile Infection?. Clinical Infectious Diseases 47:1, 63-65
CrossRef266
Wafa N. Al‐Nassir, Ajay K. Sethi, Michelle M. Nerandzic, Greg S. Bobulsky, Robin L. P. Jump, Curtis J. Donskey. (2008) Comparison of Clinical and Microbiological Response to Treatment of Clostridium difficile –Associated Disease with Metronidazole and Vancomycin. Clinical Infectious Diseases 47:1, 56-62
CrossRef267
Jennifer Peppe, Andrew Porzio, David M. Davidson. (2008) A new formulation of tolevamer, a novel nonantibiotic polymer, is safe and well-tolerated in healthy volunteers: a randomized phase I trial. British Journal of Clinical Pharmacology 66:1, 102-109
CrossRef268
Christoph von Eichel-Streiber, Veit Braun. (2008) Das difficile Clostridium / The difficile Clostridium. LaboratoriumsMedizin 32:4, 219-234
CrossRef269
Alex Carignan, Catherine Allard, Jacques Pépin, Benoit Cossette, Vincent Nault, Louis Valiquette. (2008) Risk of Clostridium difficile Infection after Perioperative Antibacterial Prophylaxis before and during an Outbreak of Infection due to a Hypervirulent Strain. Clinical Infectious Diseases 46:12, 1838-1843
CrossRef270
J. E. Emerson, R. A. Stabler, B. W. Wren, N. F. Fairweather. (2008) Microarray analysis of the transcriptional responses of Clostridium difficile to environmental and antibiotic stress. Journal of Medical Microbiology 57:6, 757-764
CrossRef271
T. I. I. van der Kooi, M. Koningstein, A. Lindemans, D. W. Notermans, E. Kuijper, R. van den Berg, H. Boshuizen, P. M. G. Filius, S. van den Hof. (2008) Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027. Journal of Medical Microbiology 57:6, 709-716
CrossRef272
Claribel P. Taylor, Sanjeev Tummala, Deborah Molrine, Lisa Davidson, Richard J. Farrell, Anthony Lembo, Patricia L. Hibberd, Israel Lowy, Ciaran P. Kelly. (2008) Open-label, dose escalation phase I study in healthy volunteers to evaluate the safety and pharmacokinetics of a human monoclonal antibody to Clostridium difficile toxin A. Vaccine 26:27-28, 3404-3409
CrossRef273
L. F. Dawson, R. A. Stabler, B. W. Wren. (2008) Assessing the role of p-cresol tolerance in Clostridium difficile. Journal of Medical Microbiology 57:6, 745-749
CrossRef274
Gregory A. Coté, Colin W. Howden. (2008) Potential adverse effects of proton pump inhibitors. Current Gastroenterology Reports 10:3, 208-214
CrossRef275
R. A. Stabler, L. F. Dawson, L. T. H. Phua, B. W. Wren. (2008) Comparative analysis of BI/NAP1/027 hypervirulent strains reveals novel toxin B-encoding gene (tcdB) sequences. Journal of Medical Microbiology 57:6, 771-775
CrossRef276
Geoffrey C. Nguyen, Gilaad G. Kaplan, Mary L. Harris, Steven R. Brant. (2008) A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. The American Journal of Gastroenterology 103:6, 1443-1450
CrossRef277
Jacques Pepin. (2008) Vancomycin for the Treatment of Clostridium difficile Infection: For Whom Is This Expensive Bullet Really Magic?. Clinical Infectious Diseases 46:10, 1493-1498
CrossRef278
Patrick G. P. Charles, Michael Whitby, Andrew J. Fuller, Robert Stirling, Alistair A. Wright, Tony M. Korman, Peter W. Holmes, Keryn J. Christiansen, Grant W. Waterer, Robert J. P. Pierce, Barrie C. Mayall, John G. Armstrong, Michael G. Catton, Graeme R. Nimmo, Barbara Johnson, Michelle Hooy, M. L. Grayson, . (2008) The Etiology of Community‐Acquired Pneumonia in Australia: Why Penicillin plus Doxycycline or a Macrolide Is the Most Appropriate Therapy. Clinical Infectious Diseases 46:10, 1513-1521
CrossRef279
Ashwin Jathavedam, Darren R. Feldman, Nicole Ishill, Stefan Turkula, Sujata Patil, George J. Bosl, Robert J. Motzer, David M. Weinstock. (2008) Infectious Complications from High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Metastatic Germ Cell Tumors. Biology of Blood and Marrow Transplantation 14:5, 595-600
CrossRef280
Jordan H. Wolff, Anna Rubin, Jeffrey D. Potter, Waymon Lattimore, Murray B. Resnick, Brian L. Murphy, Steven F. Moss. (2008) Clinical Significance of Colonoscopic Findings Associated With Colonic Thickening on Computed Tomography. Journal of Clinical Gastroenterology 42:5, 472-475
CrossRef281
M. Drees, D. R. Snydman, C. E. O’Sullivan. (2008) Repeated enzyme immunoassays have limited utility in diagnosing Clostridium difficile. European Journal of Clinical Microbiology & Infectious Diseases 27:5, 397-399
CrossRef282
Bayan Missaghi, August J. Valenti, Robert C. Owens. (2008) Clostridium difficile infection: A critical overview. Current Infectious Disease Reports 10:3, 165-173
CrossRef283
Ernst J Kuipers, Christina M Surawicz. (2008) Clostridium difficile infection. The Lancet 371:9623, 1486-1488
CrossRef284
R.-P. Vonberg, E. J. Kuijper, M. H. Wilcox, F. Barbut, P. Tüll, P. Gastmeier, , P. J. van den Broek, A. Colville, B. Coignard, T. Daha, S. Debast, B. I. Duerden, S. van den Hof, T. van der Kooi, H. J. H. Maarleveld, E. Nagy, D. W. Notermans, J. O’Driscoll, B. Patel, S. Stone, C. Wiuff. (2008) Infection control measures to limit the spread of Clostridium difficile. Clinical Microbiology and Infection 14:s5, 2-20
CrossRef285
Naomi P. O’Grady, Philip S. Barie, John G. Bartlett, Thomas Bleck, Karen Carroll, Andre C. Kalil, Peter Linden, Dennis G. Maki, David Nierman, William Pasculle, Henry Masur. (2008) Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Critical Care Medicine 36:4, 1330-1349
CrossRef286
Michael Gerber, Grit Ackermann. (2008) OPT-80, a macrocyclic antimicrobial agent for the treatment of Clostridium difficile infections: a review. Expert Opinion on Investigational Drugs 17:4, 547-553
CrossRef287
Francesca F. Norman, J. Pérez‐Molina, A. Pérez de Ayala, B. C. Jiménez, M. Navarro, R. López‐Vélez. (2008) Clostridium difficile –Associated Diarrhea after Antibiotic Treatment for Traveler’s Diarrhea. Clinical Infectious Diseases 46:7, 1060-1063
CrossRef288
Daniel M. Musher, Saima Aslam. (2008) Treatment of Clostridium Difficile Colitis in the Critical Care Setting. Critical Care Clinics 24:2, 279-291
CrossRef289
K. Blanckaert, B. Coignard, B. Grandbastien, P. Astagneau, F. Barbut. (2008) Actualités sur les infections à Clostridium difficile. La Revue de Médecine Interne 29:3, 209-214
CrossRef290
Preeta K. Kutty, Stephen R. Benoit, Christopher W. Woods, Arlene C. Sena, Susanna Naggie, Joyce Frederick, John Engemann, Sharon Evans, Brian C. Pien, Shailendra N. Banerjee, Jeffery Engel, L. Clifford McDonald. (2008) Assessment of Clostridium difficile –Associated Disease Surveillance Definitions, North Carolina, 2005 • . Infection Control and Hospital Epidemiology 29:3, 197-202
CrossRef291
Leanne B. Gasink, Ebbing Lautenbach. (2008) Prevention and Treatment of Health Care–Acquired Infections. Medical Clinics of North America 92:2, 295-313
CrossRef292
J. A. Paladino, J. J. Schentag. (2008) The Economics of Clostridium difficile-Associated Disease for Providers and Payers. Clinical Infectious Diseases 46:4, 505-506
CrossRef293
Mical S. Campbell, Keith Obstein, K. Rajender Reddy, Yu-Xiao Yang. (2008) Association between Proton Pump Inhibitor Use and Spontaneous Bacterial Peritonitis. Digestive Diseases and Sciences 53:2, 394-398
CrossRef294
Michael J. Wood, Neil Hyman, James C. Hebert, Hagen Blaszyk. (2008) Catastrophic Clostridium difficile Enteritis in a Pelvic Pouch Patient: Report of a Case. Journal of Gastrointestinal Surgery 12:2, 350-352
CrossRef295
O. Leiß, L. Bader, M. Mielke, M. Exner. (2008) Fünf Jahre Empfehlungen der Kommission für Krankenhaushygiene zur Aufbereitung flexibler Endoskope. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 51:2, 211-220
CrossRef296
Abhishek Deshpande, Chaitanya Pant, Anil Jain, Thomas G. Fraser, David D. K. Rolston. (2008) Do fluoroquinolones predispose patients to Clostridium difficile associated disease? A review of the evidence. Current Medical Research and Opinion 24:2, 329-333
CrossRef297
B. Connor. (2008) Traveler's Diarrhea Chemoprophylaxis: An Alternative Recommendation. Clinical Infectious Diseases 46:3, 475-476
CrossRef298
M. H. Wilcox, L. Mooney, R. Bendall, C. D. Settle, W. N. Fawley. (2008) A case-control study of community-associated Clostridium difficile infection. Journal of Antimicrobial Chemotherapy 62:2, 388-396
CrossRef299
John G. Bartlett, Dale N. Gerding. (2008) Clinical Recognition and Diagnosis of Clostridium difficile Infection. Clinical Infectious Diseases 46:s1, S12-S18
CrossRef300
Robert C. Owens, Jr., Curtis J. Donskey, Robert P. Gaynes, Vivian G. Loo, Carlene A. Muto. (2008) Antimicrobial‐Associated Risk Factors for Clostridium difficile Infection. Clinical Infectious Diseases 46:s1, S19-S31
CrossRef301
Dale N. Gerding, Carlene A. Muto, Robert C. Owens, Jr.. (2008) Treatment of Clostridium difficile Infection. Clinical Infectious Diseases 46:s1, S32-S42
CrossRef302
Dale N. Gerding, Carlene A. Muto, Robert C. Owens, Jr.. (2008) Measures to Control and Prevent Clostridium difficile Infection. Clinical Infectious Diseases 46:s1, S43-S49
CrossRef303
Sarah P. Hammond, Lindsey R. Baden. (2008) Antibiotic prophylaxis for patients with acute leukemia. Leukemia & Lymphoma 49:2, 183-193
CrossRef304
Lynne V McFarland. (2008) Update on the changing epidemiology of Clostridium difficile-associated disease. Nature Clinical Practice Gastroenterology & Hepatology 5:1, 40-48
CrossRef305
Roger Baxter, G. Thomas Ray, Bruce H. Fireman. (2008) Case‐Control Study of Antibiotic Use and Subsequent Clostridium difficile –Associated Diarrhea in Hospitalized Patients • . Infection Control and Hospital Epidemiology 29:1, 44-50
CrossRef306
Ted Louie. (2008) Snapshots for January 2008. Infectious Diseases in Clinical Practice 16:1, 6-8
CrossRef307
Paola Mastrantonio, Fabrizio Barbanti, Patrizia Spigaglia. (2008) Hypervirulent antibiotic-resistant Clostridium difficile in Europe. Microbial Ecology in Health and Disease 20:4, 210-212
CrossRef308
JOHN A. EVANS, DAVID G. FORCIONE, LAWRENCE S. FRIEDMAN. 2008. Gastrointestinal Complications in the Postoperative Period. , 275-347.
CrossRef309
Nadia Razaq, Susan Sambol, Kristin Nagaro, Walter Zukowski, Adam Cheknis, Stuart Johnson, Dale N. Gerding. (2007) Infection of Hamsters with Historical and Epidemic BI Types of Clostridium difficile. The Journal of Infectious Diseases 196:12, 1813-1819
CrossRef310
J. Bishara, M. Wattad, M. Paul. (2007) Vancomycin and Metronidazole for the Treatment of Clostridium difficile--Associated Diarrhea. Clinical Infectious Diseases 45:12, 1646-1647
CrossRef311
Crenguta Stepan, Christina M Surawicz. (2007) Treatment strategies for recurrent and refractory Clostridium difficile -associated diarrhea. Expert Review of Gastroenterology & Hepatology 1:2, 295-305
CrossRef312
John R. Rodney, Philip S. Barie. (2007) Difficulties with Clostridium difficile. Surgical Infections 8:6, 553-556
CrossRef313
Z.F. Gellad, B.D. Alexander, J.K. Liu, B.C. Griffith, A.M. Meyer, J.L. Johnson, A.J. Muir. (2007) Severity of Clostridium difficile-associated diarrhea in solid organ transplant patients. Transplant Infectious Disease 9:4, 276-280
CrossRef314
L. Dubreuil. (2007) Clostridium difficile : de O’Toole à 027. Antibiotiques 9:4, 268-273
CrossRef315
Marc Zerey, B. Lauren Paton, Amy E. Lincourt, Keith S. Gersin, Kent W. Kercher, B. Todd Heniford. (2007) The Burden of Clostridium difficile in Surgical Patients in the United States. Surgical Infections 8:6, 557-566
CrossRef316
Jane D. Siegel, Emily Rhinehart, Marguerite Jackson, Linda Chiarello. (2007) 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. American Journal of Infection Control 35:10, S65-S164
CrossRef317
C. Cattoen, A. Boruchowicz. (2007) Diagnostic et prise en charge thérapeutique des infections à Clostridium difficile. Antibiotiques 9:4, 278-283
CrossRef318
Robert C. Owens, August J. Valenti, Mark H. Wilcox. 2007. Clostridium difficile Infection: Overview and Update with a Focus on Antimicrobial Resistance as a Risk Factor. , 183-218.
CrossRef319
Jacques Pépin, Louis Valiquette, Sandra Gagnon, Sophie Routhier, Isabel Brazeau. (2007) Outcomes of Clostridium difficile-Associated Disease Treated With Metronidazole or Vancomycin Before and After the Emergence of NAP1/027. The American Journal of Gastroenterology 102:12, 2781-2788
CrossRef320
Jaime Belmares, Dale N. Gerding, Jorge P. Parada, Scott Miskevics, Frances Weaver, Stuart Johnson. (2007) Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system. Journal of Infection 55:6, 495-501
CrossRef321
C. A. Muto, M. K. Blank, J. W. Marsh, E. N. Vergis, M. M. O'Leary, K. A. Shutt, A. W. Pasculle, M. Pokrywka, J. G. Garcia, K. Posey, T. L. Roberts, B. A. Potoski, G. E. Blank, R. L. Simmons, P. Veldkamp, L. H. Harrison, D. L. Paterson. (2007) Control of an Outbreak of Infection with the Hypervirulent Clostridium difficile BI Strain in a University Hospital Using a Comprehensive "Bundle" Approach. Clinical Infectious Diseases 45:10, 1266-1273
CrossRef322
L. C. McDonald. (2007) Confronting Clostridium difficile in Inpatient Health Care Facilities. Clinical Infectious Diseases 45:10, 1274-1276
CrossRef323
F. Barbut, P. Mastrantonio, M. Delmée, J. Brazier, E. Kuijper, I. Poxton, . (2007) Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clinical Microbiology and Infection 13:11, 1048-1057
CrossRef324
L. V. McFarland, J. E. Clarridge, H. W. Beneda, G. J. Raugi. (2007) Fluoroquinolone Use and Risk Factors for Clostridium difficile-Associated Disease within a Veterans Administration Health Care System. Clinical Infectious Diseases 45:9, 1141-1151
CrossRef325
L. R. Peterson, R. U. Manson, S. M. Paule, D. M. Hacek, A. Robicsek, R. B. Thomson, K. L. Kaul. (2007) Detection of Toxigenic Clostridium difficile in Stool Samples by Real-Time Polymerase Chain Reaction for the Diagnosis of C. difficile-Associated Diarrhea. Clinical Infectious Diseases 45:9, 1152-1160
CrossRef326
Lacey Benson, Xiaoyan Song, Joseph Campos, Nalini Singh. (2007) Changing Epidemiology of Clostridium difficile –Associated Disease in Children • . Infection Control and Hospital Epidemiology 28:11, 1233-1235
CrossRef327
S. Paltansing, R. J. van den Berg, R. A. Guseinova, C. E. Visser, E. R. van der Vorm, E. J. Kuijper. (2007) Characteristics and incidence of Clostridium difficile-associated disease in The Netherlands, 2005. Clinical Microbiology and Infection 13:11, 1058-1064
CrossRef328
Chantri Trinh, Kavita Prabhakar. (2007) Diarrheal Diseases in the Elderly. Clinics in Geriatric Medicine 23:4, 833-856
CrossRef329
Judith A. O’Brien, Betsy J. Lahue, J. Jaime Caro, David M. Davidson. (2007) The Emerging Infectious Challenge of Clostridium difficile –Associated Disease in Massachusetts Hospitals: Clinical and Economic Consequences • . Infection Control and Hospital Epidemiology 28:11, 1219-1227
CrossRef330
M. M. Riggs, A. K. Sethi, T. F. Zabarsky, E. C. Eckstein, R. L. P. Jump, C. J. Donskey. (2007) Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Residents. Clinical Infectious Diseases 45:8, 992-998
CrossRef331
C. A. Muto. (2007) Asymptomatic Clostridium difficile Colonization: Is This the Tip of Another Iceberg?. Clinical Infectious Diseases 45:8, 999-1000
CrossRef332
Christos Gougoulias, Kieran M. Tuohy, Glenn R. Gibson. (2007) Dietary-based gut flora modulation against Clostridium difficile onset. Food Science & Technology Bulletin: Functional Foods 4:4, 31-41
CrossRef333
David Guay. (2007) Update on clindamycin in the management of bacterial, fungal and protozoal infections. Expert Opinion on Pharmacotherapy 8:14, 2401-2444
CrossRef334
Jeffrey B. Albright, Hugo Bonatti, Julio Mendez, David Kramer, John Stauffer, Ronald Hinder, Jaime A. Michel, Rolland C. Dickson, Chris Hughes, Justin Nguyen, Heidi Chua, Walter Hellinger. (2007) Early and late onset Clostridium difficile-associated colitis following liver transplantation. Transplant International 20:10, 856-866
CrossRef335
Saad Nseir, Christophe Di Pompeo. (2007) Immunosuppression and multidrug-resistant bacteria in the intensive care unit: A cohort study. Critical Care Medicine 35:10, 2466
CrossRef336
M. H. Wilcox. (2007) Evidence for low risk of Clostridium difficile infection associated with tigecycline. Clinical Microbiology and Infection 13:10, 949-952
CrossRef337
Ed J Kuijper, Jaap T van Dissel, Mark H Wilcox. (2007) Clostridium difficile: changing epidemiology and new treatment options. Current Opinion in Internal Medicine 6:5, 479-486
CrossRef338
B. Razavi, A. Apisarnthanarak, L. M. Mundy. (2007) Clostridium difficile: Emergence of Hypervirulence and Fluoroquinolone Resistance. Infection 35:5, 300-307
CrossRef339
Karl Weiss, Luc Bergeron, Harold Bernatchez, Monique Goyette, Michel Savoie, Daniel Thirion. (2007) Clostridium difficile-associated diarrhoea rates and global antibiotic consumption in five Quebec institutions from 2001 to 2004. International Journal of Antimicrobial Agents 30:4, 309-314
CrossRef340
I. Stelzmueller, H. Goegele, M. Biebl, S. Wiesmayr, N. Berger, W. Tabarelli, E. Ruttmann, J. Albright, R. Margreiter, M. Fille, H. Bonatti. (2007) Clostridium difficile Colitis in Solid Organ Transplantation—A Single-Center Experience. Digestive Diseases and Sciences 52:11, 3231-3236
CrossRef341
A. Goorhuis, T. Van der Kooi, N. Vaessen, F. W. Dekker, R. Van den Berg, C. Harmanus, S. van den Hof, D. W. Notermans, E. J. Kuijper. (2007) Spread and Epidemiology of Clostridium difficile Polymerase Chain Reaction Ribotype 027/Toxinotype III in The Netherlands. Clinical Infectious Diseases 45:6, 695-703
CrossRef342
E. Sawabe, H. Kato, K. Osawa, T. Chida, N. Tojo, Y. Arakawa, N. Okamura. (2007) Molecular analysis of Clostridium difficile at a university teaching hospital in Japan: a shift in the predominant type over a five-year period. European Journal of Clinical Microbiology & Infectious Diseases 26:10, 695-703
CrossRef343
Tin Han Htwe, Adnan Mushtaq, Sherry B. Robinson, Richard B. Rosher, Nancy Khardori. (2007) Infection in the Elderly. Infectious Disease Clinics of North America 21:3, 711-743
CrossRef344
Manfred Hauben, Sebastian Horn, Lester Reich, Muhammad Younus. (2007) Association between gastric acid suppressants and Clostridium difficile colitis and community-acquired pneumonia: analysis using pharmacovigilance tools. International Journal of Infectious Diseases 11:5, 417-422
CrossRef345
Jennifer Leonard, John K. Marshall, Paul Moayyedi. (2007) Systematic Review of the Risk of Enteric Infection in Patients Taking Acid Suppression. The American Journal of Gastroenterology 102:9, 2047-2056
CrossRef346
L. Valiquette, B. Cossette, M.-P. Garant, H. Diab, J. Pepin. (2007) Impact of a Reduction in the Use of High-Risk Antibiotics on the Course of an Epidemic of Clostridium difficile-Associated Disease Caused by the Hypervirulent NAP1/027 Strain. Clinical Infectious Diseases 45:Supplement 2, S112-S121
CrossRef347
Robert C. Owens, August J. Valenti. (2007) Clostridium difficile-Associated Disease in the New Millennium. Infectious Diseases in Clinical Practice 15:5, 299-315
CrossRef348
Patricia Muñoz, Maddalena Giannella, Luís Alcalá, Elisabeth Sarmiento, Juan Fernandez Yañez, Jesus Palomo, Pilar Catalán, Javier Carbone, Emilio Bouza. (2007) Clostridium difficile–associated Diarrhea in Heart Transplant Recipients: Is Hypogammaglobulinemia the Answer?. The Journal of Heart and Lung Transplantation 26:9, 907-914
CrossRef349
Christoph Schmidt, Birgit Löffler, Grit Ackermann. (2007) Antimicrobial phenotypes and molecular basis in clinical strains of Clostridium difficile. Diagnostic Microbiology and Infectious Disease 59:1, 1-5
CrossRef350
M. A. Miller. (2007) Clinical Management of Clostridium difficile-Associated Disease. Clinical Infectious Diseases 45:Supplement 2, S122-S128
CrossRef351
Farrin A. Manian, Sangita Aradhyula, Sandy Greisnauer, Diane Senkel, Janice Setzer, Michele Wiechens, P Lynn Meyer. (2007) Is It Clostridium difficile Infection or Something Else? A Case-control Study of 352 Hospitalized Patients With New-onset Diarrhea. Southern Medical Journal 100:8, 782-786
CrossRef352
Ciaran P. Kelly. (2007) Playing Host to the Difficult Clostridium. Clinical Gastroenterology and Hepatology 5:8, 912-914
CrossRef353
Tse Hsien Koh, Ai Ling Tan, Mee Lee Tan, Grace Wang, Keang Peng Song. (2007) Epidemiology of Clostridium difficile infection in a large teaching hospital in Singapore. Pathology 39:4, 438-442
CrossRef354
Gerald R. Donowitz, Heather L. Cox. (2007) Bacterial Community-Acquired Pneumonia in Older Patients. Clinics in Geriatric Medicine 23:3, 515-534
CrossRef355
D. B. SCHEURER, L. S. HICKS, E. F. COOK, J. L. SCHNIPPER. (2007) Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort. Epidemiology and Infection 135:06, 1010
CrossRef356
B. Elliott, B. J. Chang, C. L. Golledge, T. V. Riley. (2007) Clostridium difficile-associated diarrhoea. Internal Medicine Journal 37:8, 561-568
CrossRef357
Ashley R. Herring, John C. Williamson. (2007) Principles of Antimicrobial Use in Older Adults. Clinics in Geriatric Medicine 23:3, 481-497
CrossRef358
F. A. Zar, S. R. Bakkanagari, K. M. L. S. T. Moorthi, M. B. Davis. (2007) A Comparison of Vancomycin and Metronidazole for the Treatment of Clostridium difficile-Associated Diarrhea, Stratified by Disease Severity. Clinical Infectious Diseases 45:3, 302-307
CrossRef359
D. B. Blossom, L. C. McDonald. (2007) The Challenges Posed by Reemerging Clostridium difficile Infection. Clinical Infectious Diseases 45:2, 222-227
CrossRef360
Nicole L McMaster-Baxter, Daniel M Musher. (2007) Clostridium difficile : Recent Epidemiologic Findings and Advances in Therapy. Pharmacotherapy 27:7, 1029-1039
CrossRef361
Nilay S. Patel. (2007) FLUOROQUINOLONE USE IS THE PREDOMINANT RISK FACTOR FOR THE DEVELOPMENT OF A NEW STRAIN OF CLOSTRIDIUM DIFFICILE-ASSOCIATED DISEASE. BJU International 99:6, 1333-1334
CrossRef362
Cyrus P. Tamboli. (2007) Current Medical Therapy for Chronic Inflammatory Bowel Diseases. Surgical Clinics of North America 87:3, 697-725
CrossRef363
Christiane G. Frick, Martina Richtsfeld, Nita D. Sahani, Masao Kaneki, Manfred Blobner, J A. Jeevendra Martyn. (2007) Long-term Effects of Botulinum Toxin on Neuromuscular Function. Anesthesiology 106:6, 1139-1146
CrossRef364
John G. Bartlett. (2007) Clostridium difficile. Journal of Clinical Gastroenterology 41:Supplement 1, S24-S29
CrossRef365
S.K. Rampini, B. Lüthi, C. Ruef, R.F. Speck. (2007) Clostridium difficile assoziierter Durchfall. Der Gastroenterologe 2:3, 170-178
CrossRef366
Catherine T. Milne. (2007) ALGORITHM TO PREVENT SPREAD OF INFECTIOUS FECAL MATERIAL IN FECALLY INCONTINENT PATIENTS AND IMPROVE PERINEAL SKIN OUTCOMES. Journal of Wound, Ostomy and Continence Nursing 34:Supplement, S52-S53
CrossRef367
T. Welte. (2007) Therapie der ambulant erworbenen Pneumonie. Der Internist 48:5, 476-488
CrossRef368
Lynne V. McFarland, Henry W. Beneda, Jill E. Clarridge, Gregory J. Raugi. (2007) Implications of the changing face of Clostridium difficile disease for health care practitioners. American Journal of Infection Control 35:4, 237-253
CrossRef369
Sarah P. Hammond, Lindsey R. Baden. (2007) Antibiotic prophylaxis during chemotherapy-induced neutropenia for patients with acute leukemia. Current Hematologic Malignancy Reports 2:2, 97-103
CrossRef370
Ana P. P. Alcides, Jon S. Brazier, Leandro J. F. Pinto, Ilana T. Balassiano, Renata F. Boente, Geraldo R. Paula, Eliane O. Ferreira, Kátia E. S. Avelar, Karla R. Miranda, M. Candida S. Ferreira, Regina M. C. P. Domingues. (2007) New PCR ribotypes of Clostridium difficile detected in children in Brazil. Antonie van Leeuwenhoek 92:1, 53-59
CrossRef371
&NA;. (2007) Treatment of Clostridium difficile–Associated Disease (CDAD). Obstetrics & Gynecology 109:4, 993-995
CrossRef372
Herbert L. Dupont, Zhi–Dong Jiang, Jaime Belkind–Gerson, Pablo C. Okhuysen, Charles D. Ericsson, Shi Ke, David B. Huang, Margaret W. Dupont, Javier A. Adachi, F. Javier De La Cabada, David N. Taylor, Sridvya Jaini, Francisco Martinez Sandoval. (2007) Treatment of Travelers’ Diarrhea: Randomized Trial Comparing Rifaximin, Rifaximin Plus Loperamide, and Loperamide Alone. Clinical Gastroenterology and Hepatology 5:4, 451-456
CrossRef373
Philip Giordano, Kurt Weber, Gail Gesin, Jason Kubert. (2007) Skin and skin structure infections: treatment with newer generation fluoroquinolones. Therapeutics and Clinical Risk Management 3:2, 309-317
CrossRef374
Jeffrey Cloud, Ciaran P Kelly. (2007) Update on Clostridium difficile associated disease. Current Opinion in Internal Medicine 6:2, 131-136
CrossRef375
Gonzalo A. del Real, Mark E. Rose, Maria T. Ramirez-Atamoros, Jeffrey Hammel, Steven M. Gordon, Alejandro C. Arroliga, Mercedes E. Arroliga. (2007) Penicillin skin testing in patients with a history of β-lactam allergy. Annals of Allergy, Asthma & Immunology 98:4, 355-359
CrossRef376
Nir Peled, Silvio Pitlik, Zmira Samra, Arkadi Kazakov, Yoram Bloch, Jihad Bishara. (2007) Predicting Clostridium difficile Toxin in Hospitalized Patients With Antibiotic‐Associated Diarrhea • . Infection Control and Hospital Epidemiology 28:4, 377-381
CrossRef377
Joseph P. Mazzie, Sean R. Wilson, Michael A. Sadler, Michael Khalili, Bruce R. Javors, Shiobhan R. Weston, Douglas S. Katz. (2007) Imaging of Gastrointestinal Tract Infection. Seminars in Roentgenology 42:2, 102-116
CrossRef378
S. Hansen, S. Stamm-Balderjahn, I. Zuschneid, M. Behnke, H. Rüden, R.-P. Vonberg, P. Gastmeier. (2007) Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature. Journal of Hospital Infection 65:4, 348-353
CrossRef379
Jessica Reineke, Stefan Tenzer, Maja Rupnik, Andreas Koschinski, Oliver Hasselmayer, André Schrattenholz, Hansjörg Schild, Christoph von Eichel-Streiber. (2007) Autocatalytic cleavage of Clostridium difficile toxin B. Nature 446:7134, 415-419
CrossRef380
Perry Hookman, Jamie S. Barkin. (2007) Review: Clostridium difficile-Associated Disorders/Diarrhea and Clostridium difficile Colitis: The Emergence of a More Virulent Era. Digestive Diseases and Sciences 52:4, 1071-1075
CrossRef381
Amy Pakyz. (2007) A Case of Recurrent Clostridium difficile Diarrhea. The Consultant Pharmacist 22:3, 249-253
CrossRef382
Charles Linker. (2007) The role of autologous transplantation for acute myeloid leukemia in first and second remission. Best Practice & Research Clinical Haematology 20:1, 77-84
CrossRef383
Mazen Issa, Aravind Vijayapal, Mary Beth Graham, Dawn B. Beaulieu, Mary F. Otterson, Sarah Lundeen, Susan Skaros, Lydia R. Weber, Richard A. Komorowski, Josh F. Knox, Jeanne Emmons, Jasmohan S. Bajaj, David G. Binion. (2007) Impact of Clostridium difficile on Inflammatory Bowel Disease. Clinical Gastroenterology and Hepatology 5:3, 345-351
CrossRef384
H. Rüssmann, K. Panthel, R.-C. Bader, C. Schmitt, R. Schaumann. (2007) Evaluation of three rapid assays for detection of Clostridium difficile toxin A and toxin B in stool specimens. European Journal of Clinical Microbiology & Infectious Diseases 26:2, 115-119
CrossRef385
Fran??ois Lamontagne, Annie-Claude Labb??, Olivier Haeck, Olivier Lesur, Mathieu Lalancette, Carlos Patino, Martine Leblanc, Michel Laverdi??re, Jacques P??pin. (2007) Impact of Emergency Colectomy on Survival of Patients With Fulminant Clostridium difficile Colitis During an Epidemic Caused by a Hypervirulent Strain. Annals of Surgery 245:2, 267-272
CrossRef386
Dale N. Gerding. (2007) New Definitions Will Help, but Cultures are Critical for Resolving Unanswered Questions About Clostridium difficile • . Infection Control and Hospital Epidemiology 28:2, 113-115
CrossRef387
Kathleen M. McMullen, Jeanne Zack, Craig M. Coopersmith, Marin Kollef, Erik Dubberke, David K. Warren. (2007) Use of Hypochlorite Solution to Decrease Rates of Clostridium difficile –Associated Diarrhea • . Infection Control and Hospital Epidemiology 28:2, 205-207
CrossRef388
Steven J. Lawrence, Laura A. Puzniak, Brooke N. Shadel, Kathleen N. Gillespie, Marin H. Kollef, Linda M. Mundy. (2007) Clostridium difficile in the Intensive Care Unit: Epidemiology, Costs, and Colonization Pressure • . Infection Control and Hospital Epidemiology 28:2, 123-130
CrossRef389
Philip M. Polgreen, Yi Yi Chen, Joseph E. Cavanaugh, Melissa Ward, Stacy Coffman, Douglas B. Hornick, Daniel J. Diekema, Loreen A. Herwaldt. (2007) An Outbreak of Severe Clostridium difficile –Associated Disease Possibly Related to Inappropriate Antimicrobial Therapy for Community‐Acquired Pneumonia • . Infection Control and Hospital Epidemiology 28:2, 212-214
CrossRef390
Frederic Barbut, Beatrice Gariazzo, Laetitia Bonne, Valerie Lalande, Beatrice Burghoffer, Ralucca Luiuz, Jean‐Claude Petit. (2007) Clinical Features of Clostridium difficile –Associated Infections and Molecular Characterization of Strains: Results of a Retrospective Study, 2000‐2004 • . Infection Control and Hospital Epidemiology 28:2, 131-139
CrossRef391
B. Hubert, V. G. Loo, A.-M. Bourgault, L. Poirier, A. Dascal, E. Fortin, M. Dionne, M. Lorange. (2007) A Portrait of the Geographic Dissemination of the Clostridium difficile North American Pulsed-Field Type 1 Strain and the Epidemiology of C. difficile-Associated Disease in Quebec. Clinical Infectious Diseases 44:2, 238-244
CrossRef392
Mihaela Batke, Marcus Zervos, Barbara Robinson-Dunn, Ann L. Silverman. (2007) Clostridium difficile is the Most Common Identifiable Cause of Infectious Colitis. Infectious Diseases in Clinical Practice 15:1, 49-53
CrossRef393
Christina M. Surawicz. (2007) Antibiotics and Clostridium difficile: Cause and Cure. Journal of Clinical Gastroenterology 41:1, 1-2
CrossRef394
Diane K Wysowski. (2007) Surveillance of Prescription Drug-Related Mortality Using Death Certificate Data. Drug Safety 30:6, 533-540
CrossRef395
J.A. Stockman. (2007) A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile—Associated Diarrhea With High Morbidity and Mortality. Yearbook of Pediatrics 2007, 231-234
CrossRef396
R. Schlottmann, B. Kaup, M. Kaase, A. Tannapfel, W. E. Schmidt, F. Schmitz. (2007) Clostridium-difficile-assoziierte Erkrankungen. Der Gastroenterologe 2:1, 53-63
CrossRef397
Robert C Owens. (2007) Clostridium difficile-Associated Disease. Drugs 67:4, 487-502
CrossRef398
Patricia Fulco, Richard P Wenzel. (2006) Ramoplanin: a topical lipoglycodepsipeptide antibacterial agent. Expert Review of Anti-infective Therapy 4:6, 939-945
CrossRef399
M. Le Puil, J.P. Biggerstaff, B.L. Weidow, J.R. Price, S.A. Naser, D.C. White, R.S. Alberte. (2006) A novel fluorescence imaging technique combining deconvolution microscopy and spectral analysis for quantitative detection of opportunistic pathogens. Journal of Microbiological Methods 67:3, 597-602
CrossRef400
D. O. Lowe, M. M. Mamdani, A. Kopp, D. E. Low, D. N. Juurlink. (2006) Proton Pump Inhibitors and Hospitalization for Clostridium Difficile--Associated Disease: A Population-Based Study. Clinical Infectious Diseases 43:10, 1272-1276
CrossRef401
Japie A Louw. (2006) Peptic ulcer disease. Current Opinion in Gastroenterology 22:6, 607-611
CrossRef402
Emilio Bouza, Almudena Burillo, Patricia Muñoz. (2006) Antimicrobial Therapy of Clostridium difficile-Associated Diarrhea. Medical Clinics of North America 90:6, 1141-1163
CrossRef403
Leonard Leibovici, Mical Paul, Michael Cullen, Giampaolo Bucaneve, Anat Gafter-Gvili, Abigail Fraser, Winfried V. Kern. (2006) Antibiotic prophylaxis in neutropenic patients. Cancer 107:8, 1743-1751
CrossRef404
E. J. Kuijper, B. Coignard, P. Tull, , . (2006) Emergence of Clostridium difficile-associated disease in North America and Europe. Clinical Microbiology and Infection 12:s6, 2-18
CrossRef405
Mary E. Wilson. (2006) Editorial Commentary: Clostridium difficile and Childhood Diarrhea: Cause, Consequence, or Confounder. Clinical Infectious Diseases 43:7, 814-816
CrossRef406
David J. Weber. (2006) Collateral damage and what the future might hold. The need to balance prudent antibiotic utilization and stewardship with effective patient management. International Journal of Infectious Diseases 10, S17-S24
CrossRef407
Nathan D. Nielsen, Blythe A. Layton, L. Clifford McDonald, Dale N. Gerding, Laura A. Liedtke, Larry J. Strausbaugh. (2006) Changing Epidemiology of Clostridium difficile-Associated Disease. Infectious Diseases in Clinical Practice 14:5, 296-302
CrossRef408
Jennifer R. O'Connor, Dena Lyras, Kylie A. Farrow, Vicki Adams, David R. Powell, Jason Hinds, Jackie K. Cheung, Julian I. Rood. (2006) Construction and analysis of chromosomal Clostridium difficile mutants. Molecular Microbiology 61:5, 1335-1351
CrossRef409
Jacques Pepin. (2006) Editorial Commentary: Improving the Treatment of Clostridium difficile –Associated Disease: Where Should We Start?. Clinical Infectious Diseases 43:5, 553-555
CrossRef410
R. Fuhr, R. Stahlmann. (2006) Gastrointestinale Nebenwirkungen von Antibiotika. Der Gastroenterologe 1:3, 173-179
CrossRef411
Thomas J. Louie, Jennifer Peppe, C. Kevin Watt, David Johnson, Rasheed Mohammed, Gordon Dow, Karl Weiss, Stuart Simon, Joseph F. John, Jr., Gary Garber, Scott Chasan‐Taber, David M. Davidson, . (2006) Tolevamer, a Novel Nonantibiotic Polymer, Compared with Vancomycin in the Treatment of Mild to Moderately Severe Clostridium difficile –Associated Diarrhea. Clinical Infectious Diseases 43:4, 411-420
CrossRef412
Daniel M. Musher, Nancy Logan, Richard J. Hamill, Herbert L. DuPont, Arnold Lentnek, Arvind Gupta, Jean‐Francois Rossignol. (2006) Nitazoxanide for the Treatment of Clostridium difficile Colitis. Clinical Infectious Diseases 43:4, 421-427
CrossRef413
John G. Bartlett. (2006) Editorial Commentary: New Drugs for Clostridium difficile Infection. Clinical Infectious Diseases 43:4, 428-431
CrossRef414
Mohammed Sebaihia, Brendan W Wren, Peter Mullany, Neil F Fairweather, Nigel Minton, Richard Stabler, Nicholas R Thomson, Adam P Roberts, Ana M Cerdeño-Tárraga, Hongmei Wang, Matthew TG Holden, Anne Wright, Carol Churcher, Michael A Quail, Stephen Baker, Nathalie Bason, Karen Brooks, Tracey Chillingworth, Ann Cronin, Paul Davis, Linda Dowd, Audrey Fraser, Theresa Feltwell, Zahra Hance, Simon Holroyd, Kay Jagels, Sharon Moule, Karen Mungall, Claire Price, Ester Rabbinowitsch, Sarah Sharp, Mark Simmonds, Kim Stevens, Louise Unwin, Sally Whithead, Bruno Dupuy, Gordon Dougan, Bart Barrell, Julian Parkhill. (2006) The multidrug-resistant human pathogen Clostridium difficile has a highly mobile, mosaic genome. Nature Genetics 38:7, 779-786
CrossRef415
G. E. Stein, E. J. C. Goldstein. (2006) Fluoroquinolones and Anaerobes. Clinical Infectious Diseases 42:11, 1598-1607
CrossRef416
Cheleste M. Thorpe, Sherwood L. Gorbach. (2006) Update on Clostridium difficile. Current Treatment Options in Gastroenterology 9:3, 265-271
CrossRef417
Saima Aslam, Daniel M. Musher. (2006) An Update on Diagnosis, Treatment, and Prevention of Clostridium difficile–Associated Disease. Gastroenterology Clinics of North America 35:2, 315-335
CrossRef418
Gregory A Coté, Alan L Buchman. (2006) Antibiotic-associated diarrhoea. Expert Opinion on Drug Safety 5:3, 361-372
CrossRef419
Betsy Todd. (2006) Clostridium Difficile:Familiar Pathogen, Changing Epidemiology. AJN, American Journal of Nursing 106:5, 33-36
CrossRef420
Ed J. Kuijper, Renate J. van den Berg, Sylvia Debast, Caroline E. Visser, Dick Veenendaal, Annet Troelstra, Tjallie van der Kooi, Susan van den Hof, Daan W. Notermans. (2006) Clostridium difficile Ribotype 027, Toxinotype III, the Netherlands. Emerging Infectious Diseases 12:5, 827-830
CrossRef421
Marin H. Kollef. (2006) The Intensive Care Unit as a Research Laboratory: Developing Strategies to Prevent Antimicrobial Resistance. Surgical Infections 7:2, 85-99
CrossRef422
(2006) Epidemic Clostridium difficile. New England Journal of Medicine 354:11, 1199-1203
Full Text423
T. J. Louie. (2006) Treatment of First Recurrences of Clostridium difficile-Associated Disease: Waiting for New Treatment Options. Clinical Infectious Diseases 42:6, 765-767
CrossRef424
Rebecca Doherty. (2006) Prevalence and treatment of Clostridium difficile-related disease. Nature Clinical Practice Gastroenterology & Hepatology 3:3, 124-125
CrossRef425
Robert C Owens. (2006) Clostridium difficile –Associated Disease: An Emerging Threat to Patient Safety: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 26:3, 299-311
CrossRef426
D SNYDMAN. (2006) A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile–Associated Diarrhea With High Morbidity and MortalityLoo VG, Poirier L, Miller MA, et al (McGill Univ, Montreal; Université de Montréal; Hôpital Jean Talon, Montreal; et al) N Engl J Med 353:2442–2449, 2005§. Yearbook of Medicine 2006, 114-115
CrossRef427
Bartlett, John G., Perl, Trish M., . (2005) The New Clostridium difficile — What Does It Mean?. New England Journal of Medicine 353:23, 2503-2505
Full Text428
McDonald, L. Clifford, Killgore, George E., Thompson, Angela, Owens, Robert C. Jr., Kazakova, Sophia V., Sambol, Susan P., Johnson, Stuart, Gerding, Dale N., . (2005) An Epidemic, Toxin Gene–Variant Strain of Clostridium difficile. New England Journal of Medicine 353:23, 2433-2441
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