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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EClostridium difficile (\u003Cem\u003EC. difficile\u003C\/em\u003E) is the leading infectious cause of antibiotic-associated diarrhea in hospitals. It causes mild to moderate self-limiting diarrhea to severe inflammation of the colon, which may require surgery or result in death. Since 2000, cases of \u003Cem\u003EC. difficile\u003C\/em\u003E associated disease have increased significantly, with many patients experiencing severe inflammation of the colon [Gelone et al. ICAAC 2006 K1006].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ebacterial infections\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EClostridium difficile (\u003Cem\u003EC. difficile\u003C\/em\u003E) is the leading infectious cause of antibiotic-associated diarrhea in hospitals. It causes mild to moderate self-limiting diarrhea to severe inflammation of the colon, which may require surgery or result in death. Since 2000, cases of \u003Cem\u003EC. difficile\u003C\/em\u003E associated disease (CDAD) have increased significantly, with many patients experiencing severe inflammation of the colon [Gelone et al. ICAAC 2006 K1006].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/4\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1706997623\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/4\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/4\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/4\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10878\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EEng and colleagues presented results from a case-control retrospective study of antibiotics used and patient diagnoses in the VA New Jersey Health Care system from January 2004 to December 2005 to determine the relationship between CDAD increases and a formulary change from levofloxacin to gatifloxacin. Results presented at the 2006 ICAAC conference showed that CDAD occurred in 117 patients, 76 of which occurred after the formulary switch to gatifloxacin (p=0.049).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAnother study reported by Van Dissel and colleagues evaluated the use of immune whey protein concentrate (Anti-CD-WPC) to prevent CDAD relapse after an outbreak of \u003Cem\u003EC. difficile\u003C\/em\u003E in several hospitals in The Netherlands. Twenty one different PCR-ribotypes of \u003Cem\u003EC. difficile\u003C\/em\u003E were distinguished; 8% of CDAD cases were associated with toxin A negative\/toxin B positive strains. The most prevalent non-O27 PCR-ribotypes were 014 (19%) and 002 (11%). After completing antibiotic treatment, patients received Anti-CD-WPC 5gm tid for 2 weeks, with a 60-day follow-up. Relapse occurred in 13\/109 (12%); most of the relapses were due O27 PCR-ribotypes (16%) vs. 8% for other strains, suggesting that Anti-CD-WPC aids prevent of relapse of \u003Cem\u003EC. difficile\u003C\/em\u003E-associated diarrhea.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EIncreased virulence of CDAD is associated with high toxin production by fluoroquinolone-resistant strains belonging to ribotype 027. Nord and colleagues presented results from a study that investigated whether new drugs for Grampositive infections select for colonization of \u003Cem\u003EC. difficile\u003C\/em\u003E in humans. Twelve (12) subjects received one 1 gm dose of dalbavancin as an IV infusion and 12 received tigecycline (50mg) as IV infusions bid\/10 days. Serum and fecal samples were collected before, during, and after drug administration to determine drug concentrations and for microbiological analysis.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EFecal concentrations of dalbavancin were 6.8\u201373.4 mg\/kg (Day 5) and 7.4\u201326.4 mg\/kg (Day 14). Dalbavancin was not detected on day 60. There was some impact on the numbers of enterococci and \u003Cem\u003EEscherichia coli\u003C\/em\u003E but no changes in lactobacilli, clostridia, or bacteroides. No \u003Cem\u003EC. difficile\u003C\/em\u003E strains were recovered. Tigecycline fecal concentrations were 1.0 to 11.3 mg\/kg (Day 5) and 3.0 to 14.1 mg\/kg (Day 8). No concentrations were found on days 18 to 31. The numbers of enterococci, \u003Cem\u003EE. coli\u003C\/em\u003E, lactobacilli, and bifidobacteria were reduced, while other enterobacteria and yeasts increased. There was no impact on bacteroides. No \u003Cem\u003EC. difficile\u003C\/em\u003E strains were isolated. The investigators concluded that dalbavancin and tigecycline do not select for intestinal colonization of \u003Cem\u003EC. difficile.\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EIn most parts of the world CDAD is not required to be reported to public health authorities, resulting in a limited understanding of its epidemiology. To gain a better understanding of what is occurring with this disease, Dr. Steven Gelone and colleagues launched the first global, web-based surveillance project of CDAD (\u003Ca href=\u0022http:\/\/wwww.rmhca.com\/cdadproject\/\u0022\u003Ewwww.rmhca.com\/cdadproject\/\u003C\/a\u003E) in October 2005. As of May, 2006 there were 775 clinician respondents. A total of 630 (81%) were from the US and 145 (19%) were from the rest of the world (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Gelone et al. ICAAC 2006 K1006].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/10881\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/10881\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10881\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1:\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EUS versus Rest of World (ROW) Results\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIncreased participation in this worldwide surveillance project would contribute to a better understanding of the epidemiology of CDAD.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/4\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm5a1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm5a1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm5a1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}