• 한국콘텐츠학회논문지
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• 제10권5호
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• pp.259-266
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• 2010

Clostridium difficile 연관 설사증은 항생제 관련 병원 감염 설사에 매우 중요하며, 최근 병원 내 C. difficile 감염 발생률은 계속 증가해왔다. 본 연구에서는 2005년 1월부터 2008년 12월까지 대변 총 1,329 검체를 검사 하여, C. difficile 발생률과 감염 특성을 분석하였다. 전체 1,329 검체 중 독소 A/B검사(EIA)양성 반응을 나타낸 검체는 총283건이었다. 4년간 평균 양성률은 21.2%였으며, 연령 분포에서는 70세 이상에서 가장 높았다. 내시경 소견에서 PMC 57.7%, 정상 소견 19.5%였으며, 조직학적 소견에서는 PMC26.8%, AAC 52.2% 였다. C. difficile 은 PMC 와 관련이 있으나, 내시경 검사 및 조직 검사 소견에서는 정상에서 PMC 까지 다양하게 나타났다.

• 한국임상약학회지
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• 제20권1호
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• pp.78-84
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• 2010

Background: Clostridium difficile is the primary reason of the nosocomial diarrhea. The antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile associated diarrhea (CDAD). Although nearly all classes of antimicrobial agents have been associated with CDAD, clindamycin and the third-generation cephalosporins have traditionally been considered to the greatest risk factor. Recent studies have also implicated fluoroquinolones as high-risk agents due to increasing use of the agents. This study was to determine the incidence and the risk factors of CDAD related to the administered antibiotics and to assess the therapeutic regimen of metronidazole or vancomycin based on the C. difficile toxin assay Methods: A retrospective study was performed in patients with Clostridium difficile toxin assay at I Hospital (Incheon, South Korea) during the period from January 2007 through December 2007. Administrative, laboratory, and pharmacy data were collected from Electronic Medical Databases. Results: The analysis included 129 reported C.difficile toxin assay results, with 42 positive cases and 87 negative cases. Significant antibiotic risk factors for CDAD included the use of the fourth-generation cephalosporinse (OR=5.97, 95% CI 1.37-25.98, P=0.017). Administration of metronidazole was protective against CDAD (OR=0.30, 95% CI 0.12-0.74, P=0.009). Prolonged antimicrobial therapy has been associated with an increased risk of CDAD. The third-generation cephalosporins (OR=3.81, 95% CI 1.08-13.41, P=0.037) and aminoglycoside (OR=5.50, 95% CI 1.43-21.10, P=0.013) demonstrated greater risk for CDAD over 15 days than 8days or less days of treatment duration. Conclusions: The fourth and third generation cephalosporin, aminglycoside were the significant risk factors compared with other antibiotics, whereas metronidazole appears to be protective. The longer duration of antiobiotic use increased CDAD.

• 미생물학회지
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• 제54권3호
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• pp.214-221
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• 2018

Clostridium difficile infection (CDI) is a rapidly emerging infection that may have devastating consequences. Prompt and accurate diagnosis is crucial for management and control. The aim of this study was to determine the incidence of C. difficile associated diarrhea among hospitalized patients, and to compare different diagnostic laboratory methods for detection of toxin producing strains in clinical specimens. The study was conducted at a university hospital in Cairo during the period from May 2013 till June 2015. Subjects were under antibiotic therapy and presented with hospital-acquired diarrhea. Four hundred and sixty-five stool specimens were processed by different microbiological methods. C. difficile was recovered in culture in 51 of stool specimens. Of these, 86.3% to 98% were positive for toxin production by 2 different methods. This study showed that antibiotic intake is the major risk factor for development of hospital-acquired diarrhea. We evaluated different microbiological methods for diagnosis of C. difficile. We recommend the use of toxigenic culture as a gold standard for microbiological diagnosis of C. difficile.

• 한국의료질향상학회지
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• 제8권1호
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• pp.10-21
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• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

• 한국축산식품학회지
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• 제41권5호
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• pp.883-893
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• 2021

Clostridium difficile present in feces of food animals may contaminate their meats and act as a potential source of C. difficile infection (CDI) to humans. C. difficile resistance to antibiotics, its production of toxins and spores play major roles in the pathogenesis of CDI. This is the first study to evaluate C. difficile prevalence in retail raw animal meats, its antibiotics susceptibilities and toxigenic activities in Al-Jouf, Saudi Arabia. Totally, 240 meat samples were tested. C. difficile was identified by standard microbiological and biochemical methods. Vitek-2 compact system confirmed C. difficile isolates were 15/240 (6.3%). Toxins A/B were not detected by Xpect C. difficile toxin A/B tests. Although all isolates were susceptible to vancomycin and metronidazole, variable degrees of reduced susceptibilities to moxifloxacin, clindamycin or tetracycline antibiotics were detected by Epsilon tests. C. difficile strains with reduced susceptibility to antibiotics should be investigated. Variability between the worldwide reported C. difficile contamination levels could be due to absence of a gold standard procedure for its isolation. Establishment of a unified testing algorithm for C. difficile detection in food products is definitely essential to evaluate the inter-regional variation in its prevalence on national and international levels. Proper use of antimicrobials during animal husbandry is crucial to control the selective drug pressure on C. difficile strains associated with food animals. Investigating the protective or pathogenic potential of non-toxigenic C. difficile strains and the possibility of gene transfer from certain toxigenic/ antibiotics-resistant to non-toxigenic/antibiotics-sensitive strains, respectively, should be worthy of attention.

• 대한임상검사과학회지
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• 제46권4호
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• pp.140-142
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• 2014

To evaluate the recovery rates to increase toxigenic C. difficile, the selective enrichment broth culture methods were compared with commonly used cytotoxin assays and toxigenic culture. First, the enrichment culture, using the selective medium broth for 2 to 5 days, was performed and then, toxigenic C. difficile was confirmed by C. difficile toxin gene-specific PCR after being cultured on C. difficile selective agar. The sensitivity of C. difficile from the enrichment culture (100%) was higher than that of C. difficile selective agar culture (93.8%), while positive predictive values (PPV) were low; 72.7% (16/22) and 88.2% (15/17). PPV of the enrichment culture are not high. Recently, combinations of C. difficile selective agar culture, C. difficile A & B assays, glutamate dehydrogenase, and nucleic acid amplification method are widely used. The enrichment culture was disadvantageous in PPV, turn-around time, and cost. So, what we performed is not considered as a common method of diagnosis of C. difficile-associated diarrhea.

• Journal of Microbiology and Biotechnology
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• 제27권6호
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• pp.1163-1170
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• 2017

Clostridium difficile releases two exotoxins, toxin A and toxin B, which disrupt the epithelial cell barrier in the gut to increase mucosal permeability and trigger inflammation with severe diarrhea. Many studies have suggested that enteric nerves are also directly involved in the progression of this toxin-mediated inflammation and diarrhea. C. difficile toxin A is known to enhance neurotransmitter secretion, increase gut motility, and suppress sympathetic neurotransmission in the guinea pig colitis model. Although previous studies have examined the pathophysiological role of enteric nerves in gut inflammation, the direct effect of toxins on neuronal cells and the molecular mechanisms underlying toxin-induced neuronal stress remained to be unveiled. Here, we examined the toxicity of C. difficile toxin A against neuronal cells (SH-SY5Y). We found that toxin A treatment time- and dose-dependently decreased cell viability and triggered apoptosis accompanied by caspase-3 activation in this cell line. These effects were found to depend on the up-regulation of reactive oxygen species (ROS) and the subsequent activation of p38 MAPK and induction of $p21^{Cip1/Waf1}$. Moreover, the N-acetyl-$\text\tiny L$-cysteine (NAC)-induced down-regulation of ROS could recover the viability loss and apoptosis of toxin A-treated neuronal cells. These results collectively suggest that C. difficile toxin A is toxic for neuronal cells, and that this is associated with rapid ROS generation and subsequent p38 MAPK activation and $p21^{Cip1/Waf1}$ up-regulation. Moreover, our data suggest that NAC could inhibit the toxicity of C. difficile toxin A toward enteric neurons.

• 대한의생명과학회지
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• 제26권3호
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• pp.210-216
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• 2020

The purpose of this study was to evaluate GDH & Toxin (GDT) tests for the identification of the presence of Clostridioides difficile (C. difficile) as well as to detect whether any toxin was present in the feces of patients suspected of diarrhea associated with C. difficile. Data related to the results of toxin and culture (TC) tests and GDT tests conducted on patients with diarrhea and suspected CDI between January 2017 and august 2018, positive test rates, patient ages and sexes, whether the patients were hospitalized, and turnaround time (TAT) were analyzed retrospectively. Of the 7,554 total tests conducted for CDI diagnosis, 1,010 TC tests (14.9%) were positive, while 92 GDT tests (12.0%) were positive. Of these positive cases, 815 (80.7%) identified through TC test and 80 (87%) identified through GDT test were inpatients. also, among the patients with positive test results, 497 (49.2%) diagnosed through TC test and 45 (48.9%) diagnosed through GDT test were aged 61 years or older. The total time required to complete a TC test was 83.6 hours, while the time required for a GDT test was 11.2 hours, equating to an approximately three-day difference between the two tests. The detection of toxin-producing C. difficile is important in CDI diagnosis, but the commonly used Enzymeimmunoassay (EIA) toxin tests with low sensitivity result in delayed CDI diagnosis time. Therefore, primary screening tests for CDI diagnosis using the GDT method and secondary tests using additional methods are considered most effective.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권1호
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• pp.47-54
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• 2017

Purpose: Clinical symptoms associated with Clostridium difficile infection (CDI) can vary widely. Carrier state without apparent symptoms is relatively common during infancy. The objective of this study was to determine the association of C. difficile colonization with bowel habit change and the effect of C. difficile colonization treatment on restoration of normal bowel habit. Methods: Between 2006 and 2014, infants at 1 to 12 months of age with diarrhea for more than 2 weeks who did not improve with conservative care were recruited from Gachon University Gil Medical Center. Infants who were followed up for at least 7 days were included. The presence or absence of C. difficile colonization, effect of metronidazole, and other medical records were reviewed. To determine the association between CDI and bowel habit change, logistic regression analysis was used. Results: Of a total of 126 infants, 74 (58.7%) were male patients. Of the 126 patients, 27 (21.4%) had C. difficile colonization. Significant (p<0.05) risk factors for C. difficile colonization included artificial milk feeding (odds ratio [OR], 4.310; 95% confidence interval [CI], 1.564-11.878), prior rotavirus vaccination (OR, 4.322; 95% CI, 1.018-18.349), and antibiotic use (OR, 4.798; 95% CI, 1.430-16.101). There was improvement in bowel habit after metronidazole therapy (OR, 0.34; 95% CI, 0.15-0.79; p<0.05), regardless of the presence or absence of C. difficile colonization, Conclusion: There was no significant correlation between bowel habit change and C. difficile colonization during infancy. However, metronidazole can be used as an optional method to manage functional gastrointestinal disorders.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제5권2호
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• pp.143-149
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• 2002

목 적: 최근 항생제 사용의 증가로 소아에서 C. difficile 장염의 빈도도 증가하였다. 우리나라 소아에서 C. difficile 장염과 항생제와의 관련성에 대한 체계적인 보고는 아직 없기에 저자들은 우리나라 소아에서 C. difficile의 장염과 항생제와의 관련성을 파악하고, 나아가 C. difficile의 진단 및 치료에 도움이 되고자 이번 연구를 수행하였다. 방 법: 2000년 1월 1일부터 2002년 6월 30일까지 서울대학교병원을 내원한 소아 환자 중, 설사가 있으면서 대변 배양에서 C. difficile이 나온 85례를 대상으로 하여, 후향적으로 환자의 의무 기록지를 참고하여 항생제 사용 유무, 사용하였던 항생제의 종류, 항생제 사용 시작 시점과 C. difficile 대변 배양 검사와의 기간 등에 대하여 조사하였다. 대상 환아는 남아가 50례 여아가 35례로 남녀비는 1.4 : 1이었고, 평균 연령은 2.5세이었다. 결 과: 1) 대상 환아는 남아가 50례 여아가 35례로 남녀비는 1.4 : 1 이었고, 평균 연령은 2.5세이었다. 2) 항생제 투여 여부가 불확실한 환아 3명을 제외한 82명의 환아 중, 3달 이내에 항생제를 투여받은 환아가 55명(67%)이었고, 항생제 투여를 받지 않은 환아가 27명(33%)이었다. 3) 대변배양검사를 할 때 항생제를 쓰고 있었던 경우는 43명(78%)이었고, 항생제를 끊고 난 후였던 경우도 12명(22%)이나 되었다. 4) 항생제를 쓰고 있었던 환아 43명 중, 항생제를 처음 투여하기 시작한 시점에서 균 배양까지 걸린 기간은 1일 미만이 5명(12%), 1일 이상 3일 미만이 9명(21%), 3일 이상 1주 미만이 10명(23%), 1주 이상 2주 미만이 10명(23%), 2주 이상 3주 미만이 6명(14%), 4주 이상 5주 미만이 1명, 6주 이상 7주 미만이 7명이었다. 1명은 방광요관 역류가 있어 10개월 전부터 예방적 항생제를 복용하고 있었다. 5) 대변배양검사 당시 항생제를 이미 끊었던 12명의 환아 중, 항생제를 끊은 뒤 대변배양검사까지 기간은 1일에서 3일 사이가 2명, 3일에서 1주일 사이가 3명, 1주에서 2주 사이가 5명이었고, 4주에서 5주 사이가 1명, 7주에서 8주 사이가 1명이었다. 6) 24명(44%)은 1가지 항생제를 투여 받았고, 31명(56%)은 2가지 이상의 항생제를 투여 받았다. 7) 사용된 항생제는 cefotaxime이 20례로 가장 많았고, amikacin 15례, ampicillin 13례, cefazolin, vancomycin 각각 8례 순이었다. 결 론: 특히 어린 연령 층의 소아 설사 환자에서 항생제 사용 중이거나, 최근 항생제 사용력이 있었던 경우 C. difficile 장염을 의심하는 것이 빠른 진단과 치료에 도움이 될 것이다.