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Darkoh C, Kaplan HB, DuPont HL. Harnessing the glucosyltransferase activities of Clostridium difficile for functional studies of toxins A and B. J Clin Microbiol 2011; 49:2933-41. [PMID: 21653766 PMCID: PMC3147749 DOI: 10.1128/jcm.00037-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 05/31/2011] [Indexed: 12/18/2022] Open
Abstract
The incidence of Clostridium difficile infection (CDI) has been increasing within the last decade. Pathogenic strains of C. difficile produce toxin A and/or toxin B, which are important virulence factors in the pathogenesis of this bacterium. Current methods for diagnosing CDI are mostly qualitative tests that detect either the bacterium or the toxins. We have developed an assay (Cdifftox activity assay) to detect C. difficile toxin A and B activities that is quantitative and cost-efficient and utilizes a substrate that is stereochemically similar to the native substrate of the toxins (UDP-glucose). To characterize toxin activity, toxins A and B were purified from culture supernatants by ammonium sulfate precipitation and chromatography through DEAE-Sepharose and gel filtration columns. The activities of the final fractions were quantitated using the Cdifftox activity assay and compared to the results of a toxin A- and B-specific enzyme-linked immunosorbent assay (ELISA). The affinity for the substrate was >4-fold higher for toxin B than for toxin A. Moreover, the rate of cleavage of the substrate was 4.3-fold higher for toxin B than for toxin A. The optimum temperature for both toxins ranged from 35 to 40°C at pH 8. Culture supernatants from clinical isolates obtained from the stools of patients suspected to be suffering from CDI were tested using the Cdifftox activity assay, and the results were compared to those of ELISA and PCR amplification of the toxin genes. Our results demonstrate that this new assay is comparable to the current commercial ELISA for detecting the toxins in the samples tested and has the added advantage of quantitating toxin activity.
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Affiliation(s)
- Charles Darkoh
- The University of Texas Graduate School of Biomedical Sciences
- The University of Texas School of Public Health Center for Infectious Diseases
| | - Heidi B. Kaplan
- The University of Texas Graduate School of Biomedical Sciences
- The University of Texas Medical School
| | - Herbert L. DuPont
- The University of Texas Graduate School of Biomedical Sciences
- The University of Texas Medical School
- The University of Texas School of Public Health Center for Infectious Diseases
- St. Luke's Episcopal Hospital
- Baylor College of Medicine, Houston, Texas
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52
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Kuehne SA, Cartman ST, Minton NP. Both, toxin A and toxin B, are important in Clostridium difficile infection. Gut Microbes 2011; 2:252-5. [PMID: 21804353 PMCID: PMC3260544 DOI: 10.4161/gmic.2.4.16109] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The bacterium Clostridium difficile is the leading cause of healthcare associated diarrhoea in the developed world and thus presents a major financial burden. The main virulence factors of C. difficile are two large toxins, A and B. Over the years there has been some debate over the respective roles and importance of these two toxins. To address this, we recently constructed stable toxin mutants of C. difficile and found that they were virulent if either toxin A or toxin B was functional. This underlined the importance of each toxin and the necessity to consider both when developing countermeasures against Clostridium difficile infection (CDI). In this article we discuss our findings in the context of previous work and outline some of the challenges which face the field as a result.
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53
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Expression, purification and cell cytotoxicity of actin-modifying binary toxin from Clostridium difficile. Protein Expr Purif 2010; 74:42-8. [DOI: 10.1016/j.pep.2010.04.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/21/2010] [Accepted: 04/21/2010] [Indexed: 02/04/2023]
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54
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Kuehne SA, Cartman ST, Heap JT, Kelly ML, Cockayne A, Minton NP. The role of toxin A and toxin B in Clostridium difficile infection. Nature 2010; 467:711-3. [PMID: 20844489 DOI: 10.1038/nature09397] [Citation(s) in RCA: 613] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 08/06/2010] [Indexed: 12/23/2022]
Abstract
Clostridium difficile infection is the leading cause of healthcare-associated diarrhoea in Europe and North America. During infection, C. difficile produces two key virulence determinants, toxin A and toxin B. Experiments with purified toxins have indicated that toxin A alone is able to evoke the symptoms of C. difficile infection, but toxin B is unable to do so unless it is mixed with toxin A or there is prior damage to the gut mucosa. However, a recent study indicated that toxin B is essential for C. difficile virulence and that a strain producing toxin A alone was avirulent. This creates a paradox over the individual importance of toxin A and toxin B. Here we show that isogenic mutants of C. difficile producing either toxin A or toxin B alone can cause fulminant disease in the hamster model of infection. By using a gene knockout system to inactivate the toxin genes permanently, we found that C. difficile producing either one or both toxins showed cytotoxic activity in vitro that translated directly into virulence in vivo. Furthermore, by constructing the first ever double-mutant strain of C. difficile, in which both toxin genes were inactivated, we were able to completely attenuate virulence. Our findings re-establish the importance of both toxin A and toxin B and highlight the need to continue to consider both toxins in the development of diagnostic tests and effective countermeasures against C. difficile.
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Affiliation(s)
- Sarah A Kuehne
- Clostridia Research Group, Centre for Biomolecular Sciences, School of Molecular Medical Sciences, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit, University of Nottingham, Nottingham NG7 2RD, UK
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55
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Sun X, Savidge T, Feng H. The enterotoxicity of Clostridium difficile toxins. Toxins (Basel) 2010; 2:1848-80. [PMID: 22069662 PMCID: PMC3153265 DOI: 10.3390/toxins2071848] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 06/23/2010] [Accepted: 07/09/2010] [Indexed: 02/06/2023] Open
Abstract
The major virulence factors of Clostridium difficile infection (CDI) are two large exotoxins A (TcdA) and B (TcdB). However, our understanding of the specific roles of these toxins in CDI is still evolving. It is now accepted that both toxins are enterotoxic and proinflammatory in the human intestine. Both purified TcdA and TcdB are capable of inducing the pathophysiology of CDI, although most studies have focused on TcdA. C. difficile toxins exert a wide array of biological activities by acting directly on intestinal epithelial cells. Alternatively, the toxins may target immune cells and neurons once the intestinal epithelial barrier is disrupted. The toxins may also act indirectly by stimulating cells to produce chemokines, proinflammatory cytokines, neuropeptides and other neuroimmune signals. This review considers the mechanisms of TcdA- and TcdB-induced enterotoxicity, and recent developments in this field.
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Affiliation(s)
- Xingmin Sun
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA, 01536, USA;
| | - Tor Savidge
- The University of Texas Medical Branch, Galveston, TX, 77555, USA;
| | - Hanping Feng
- Tufts Cummings School of Veterinary Medicine, North Grafton, MA, 01536, USA;
- Author to whom correspondence should be addressed; ; Tel.: +1-508-887-4252; Fax: +1-508-839-7911
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56
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Development of Candida albicans colitis in a child undergoing steroid therapy for ulcerative colitis. J Pediatr Gastroenterol Nutr 2010; 51:96-9. [PMID: 20543725 DOI: 10.1097/mpg.0b013e31818de1ba] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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57
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Steele J, Feng H, Parry N, Tzipori S. Piglet models of acute or chronic Clostridium difficile illness. J Infect Dis 2010; 201:428-34. [PMID: 20039803 DOI: 10.1086/649799] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We examined the piglet model of Clostridium difficile illness (CDI) in humans, because swine are naturally susceptible to C. difficile. The piglet is a reproducible model of acute or chronic CDI with characteristic pseudomembranous colitis. Germ-free piglets were consistently and extensively colonized after oral challenge with the human strain 027/BI/NAP1, establishing an infectious dose-age relationship. This allowed a demarcation between acute fatal and chronic models. The clinical manifestations of disease inclusive of gastrointestinal and systemic symptoms and characteristic mucosal lesions of the large bowel (including pseudomembranous colitis) are described. Additionally, we demonstrate the presence of toxins in feces, body fluids, and serum and a significant elevation in interleukin 8 levels in animals with severe disease. We conclude that piglets infected with C. difficile mimic many of the key characteristics observed in humans with CDI and are suitable animals in which to investigate the role played by virulence attributes, drug efficacy, and vaccine candidates.
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Affiliation(s)
- Jennifer Steele
- Division of Infectious Diseases, Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
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58
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Fenollar F. Chronic diarrhea. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Characterization of the sporulation initiation pathway of Clostridium difficile and its role in toxin production. J Bacteriol 2009; 191:7296-305. [PMID: 19783633 DOI: 10.1128/jb.00882-09] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Clostridium difficile is responsible for significant mortality and morbidity in the hospitalized elderly. C. difficile spores are infectious and are a major factor contributing to nosocomial transmission. The Spo0A response regulator is the master regulator for sporulation initiation and can influence many other cellular processes. Using the ClosTron gene knockout system, we inactivated genes encoding Spo0A and a putative sporulation-associated sensor histidine kinase in C. difficile. Inactivation of spo0A resulted in an asporogeneous phenotype, whereas inactivation of the kinase reduced C. difficile sporulation capacity by 3.5-fold, suggesting that this kinase also has a role in sporulation initiation. Furthermore, inactivation of either spo0A or the kinase resulted in a marked defect in C. difficile toxin production. Therefore, Spo0A and the signaling pathway that modulates its activity appear to be involved in regulation of toxin synthesis in C. difficile. In addition, Spo0A was directly phosphorylated by a putative sporulation-associated kinase, supporting the hypothesis that sporulation initiation in C. difficile is controlled by a two-component signal transduction system rather than a multicomponent phosphorelay. The implications of these findings for C. difficile sporulation, virulence, and transmission are discussed.
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60
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Von Abercron SMM, Karlsson F, Wigh GT, Wierup M, Krovacek K. Low occurrence of Clostridium difficile in retail ground meat in Sweden. J Food Prot 2009; 72:1732-4. [PMID: 19722410 DOI: 10.4315/0362-028x-72.8.1732] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This pilot study was conducted to evaluate the occurrence of Clostridium difficile in samples of ground meat in Sweden. From April to September 2008, 82 meat samples were collected from randomly selected retail shops in Uppsala County (central Sweden). C. difficile was isolated from 2 (2.4%; both ground beef) of the 82 meat samples. No C. difficile was detected in pork, hamburger, sheep, poultry, or other type of meat samples. The two C. difficile isolates produced both toxin A and toxin B. These findings indicate that C. difficile might be present in ground meat samples in Sweden. However, further studies are necessary to confirm these preliminary data and to elucidate the public health significance of meat contamination by C. difficile in Sweden.
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Affiliation(s)
- Sophie Marie Martirani Von Abercron
- Department of Biomedical Sciences and Veterinary Public Health, Section of Bacteriology and Food Safety, Box 7009, 75007 SLU, Uppsala, Sweden
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Rahier JF, Ben-Horin S, Chowers Y, Conlon C, De Munter P, D'Haens G, Domènech E, Eliakim R, Eser A, Frater J, Gassull M, Giladi M, Kaser A, Lémann M, Moreels T, Moschen A, Pollok R, Reinisch W, Schunter M, Stange EF, Tilg H, Van Assche G, Viget N, Vucelic B, Walsh A, Weiss G, Yazdanpanah Y, Zabana Y, Travis SPL, Colombel JF. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2009; 3:47-91. [PMID: 21172250 DOI: 10.1016/j.crohns.2009.02.010] [Citation(s) in RCA: 366] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 02/24/2009] [Accepted: 02/25/2009] [Indexed: 02/08/2023]
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Miller AT, Tabrizian P, Greenstein AJ, Dikman A, Byrn J, Divino C. Long-term follow-up of patients with fulminant Clostridium difficile colitis. J Gastrointest Surg 2009; 13:956-9. [PMID: 19224298 DOI: 10.1007/s11605-009-0819-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 01/28/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to determine the long-term survival rate, rate of gastrointestinal continuity restoration, and rate of recurrence following an attack of fulminant Clostridium difficile colitis. MATERIAL AND METHODS Fulminant C. difficile colitis was defined as any patient who had a bout of C. difficile colitis and required surgical intervention after failing medical therapy. These patients were found through a pathological database search. Follow-up phone calls were made to any patient who survived at least 30 days after being discharged from the hospital following surgical intervention (long-term survivor group). RESULTS A total of 49 patients were involved in the study. The 30-day mortality rate was 57% (28/49), with an in-hospital mortality rate of 49%. The 5-year survival rate for the long-term survival group was 38% (8/21) and 16.3% for all patients. Gastrointestinal continuity was restored in 20% of the patients. There was one documented recurrence of C. difficile colitis CONCLUSION Patients who have a bout of fulminant C. difficile colitis have a poor prognosis of surviving longer than 5 years. Restoring gastrointestinal continuity is uncommon and usually reserved for patients with few co-morbidities. Recurrent C. difficile colitis after surgical resection is a rare occurrence.
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Affiliation(s)
- Aaron T Miller
- Department of Surgery, Mount Sinai School of Medicine, 5 E. 98th Street, 15th Floor, Box 1259, New York, NY 10029, USA
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63
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Jaksic AS, Nimmo GR, Dwyer BW. Laboratory diagnosis of Clostridium difficile-associated diarrhoea: microbiologists (should) do it with culture. Pathology 2009; 41:187-8. [PMID: 19152191 DOI: 10.1080/00313020802579235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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64
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Clostridium difficile-associated enteric disease after percutaneous endoscopic gastrostomy. J Gastroenterol 2009; 44:121-5. [PMID: 19214673 DOI: 10.1007/s00535-008-2283-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/15/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) has become established as a useful enteral nutrition technique. Although various adverse events related to PEG are known, few reports have described Clostridium difficile-associated enteric disease (CDED) after PEG. We encountered several cases of CDED with onset soon after PEG. The present study examined these cases in detail and analyzed potential risk factors. METHODS A total of 239 patients underwent PEG at our hospital from 1999, and the subjects comprised 233 patients for whom data could be statistically analyzed. CDED with onset soon after PEG was defined for cases with symptoms within 1 month after PEG. We investigated features and prognosis of these cases. A total of 19 predictors were chosen, and logistic regression analysis was performed using CDED with onset soon after PEG as a dependent variable. RESULTS Mean patient age was high, and about 65% were men. Their body weights were low and their general condition was markedly poor. CDED with onset soon after PEG was shown in 15 patients (6.4%). Although oral administration of vancomycin resulted in prompt recovery in most cases, enteral nutrition was interrupted for a long period, and the general condition deteriorated markedly in two patients. Logistic regression analysis identified "past history of CDED" and "antibiotic dosing period at PEG" as risk factors for CDED onset soon after PEG. CONCLUSIONS CDED occurred with onset soon after PEG at a comparatively high rate. Our analysis suggested "past history of CDED" and "antibiotic dosing period at PEG" as risk factors for CDED after PEG.
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Abstract
Clostridium difficile is a Gram-positive, spore-forming, anaerobe and is the leading cause of antibiotic-associated diarrhea, pseudomembranous colitis, and toxic megacolon. Essential to the lifestyle of C. difficile is the ability to form a metabolically dormant spore, germinate, and grow out upon appropriate signals and elicit disease with the secretion of two toxins. To aid in the study of this organism, this unit describes the growth and maintenance of C. difficile. Included are methods to isolate C. difficile from environmental samples, grow in laboratory medium, and produce and purify spores.
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Affiliation(s)
- Joseph A Sorg
- Department of Molecular Biology and Microbiology, Tufts University, Boston, Massachusetts, USA
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66
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Park BS, Kim JH, Seo HI, Kim HS, Kim DH, Cho HJ, Jeon TY, Kim DH, Sim MS, Kim S, Kang HS. Pseudomembranous Colitis after Gastrointestinal Operation. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.2.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Byung Soo Park
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Jae Hun Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Hyun Sung Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Dae Hwan Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Hong Jae Cho
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Tae Yong Jeon
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Dong Heon Kim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Mun Sup Sim
- Department of Surgery, Postgraduate School of Medicine, Pusan National University, Busan, Korea
| | - Suk Kim
- Department of Radiology, Postgraduate School of Medicine, Pusan National University, Busan, Korea
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67
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Blondeau JM. What have we learned about antimicrobial use and the risks for Clostridium difficile-associated diarrhoea? J Antimicrob Chemother 2008; 63:238-42. [PMID: 19028718 DOI: 10.1093/jac/dkn477] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clostridium difficile is recognized as a major cause of antibiotic-associated diarrhoea and colitis. Antimicrobial agents have been repeatedly recognized as a causative risk for C. difficile-associated diarrhoea (CDAD) and more recently fluoroquinolones have been particularly implicated. Unfortunately, not all reports of antimicrobial associations with CDAD have excluded variables other than antimicrobial use. Prevention of CDAD usually involves infection control interventions and antimicrobial restriction policies may not be fully substantiated by currently available data; however, antimicrobial drug restriction seems prudent in outbreak situations.
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Affiliation(s)
- J M Blondeau
- Department of Clinical Microbiology, Royal University Hospital and Saskatoon Health Region, Saskatoon, Saskatchewan, Canada.
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68
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Molecular characterization of a Clostridium difficile bacteriophage and its cloned biologically active endolysin. J Bacteriol 2008; 190:6734-40. [PMID: 18708505 DOI: 10.1128/jb.00686-08] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Clostridium difficile infection is increasing in both frequency and severity, with the emergence of new highly virulent strains highlighting the need for more rapid and effective methods of control. Here, we show that bacteriophage endolysin can be used to inhibit and kill C. difficile. The genome sequence of a novel bacteriophage that is active against C. difficile was determined, and the bacteriophage endolysin gene was subcloned and expressed in Escherichia coli. The partially purified endolysin was active against 30 diverse strains of C. difficile, and importantly, this group included strains of the major epidemic ribotype 027 (B1/NAP1). In contrast, a range of commensal species that inhabit the gastrointestinal tract, including several representatives of the clostridium-like Firmicutes, were insensitive to the endolysin. This endolysin provides a platform for the generation of both therapeutic and detection systems to combat the C. difficile problem. To investigate a method for the protected delivery and production of the lysin in the gastrointestinal tract, we demonstrated the expression of active CD27L endolysin in the lactic acid bacterium Lactococcus lactis MG1363.
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69
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Fernández de la Puente E, Gómez Pavón J, Bermejo Boixareu C, Rodríguez Salazar J, Cortés Bohórquez R, Ruipérez Cantera I. [Results of the application of a prevention protocol for Clostridium difficile infection in an acute geriatric unit]. Rev Esp Geriatr Gerontol 2008; 43:125-126. [PMID: 18682125 DOI: 10.1016/s0211-139x(08)71167-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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70
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Menon S. Primary prophylaxis of SBP. Gastroenterology 2008; 134:643-4; author reply 644. [PMID: 18242238 DOI: 10.1053/j.gastro.2007.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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