About which medication would the nurse teach the patient who is prescribed an antiperistaltic agent

1. Bartlett J.G., Chang T.W., Gurwith M., Gorbach S.L., Onderdonk A.B. Antibiotic-associated pseudomembranous colitis due to toxin-producing Clostridia. N Engl J Med. 1978;298(10):531–534. [PubMed] [Google Scholar]

2. Khanna S., Pardi D.S. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol. 2010;4(4):409–416. [PubMed] [Google Scholar]

3. Loo V.G., Poirier L., Miller M.A. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality [published correction appears in N Engl J Med. 2006;354(20):2200] N Engl J Med. 2005;353(23):2442–2449. [PubMed] [Google Scholar]

4. Khanna S., Pardi D.S., Aronson S.L. The epidemiology of community-acquired Clostridium difficile infection: a population-based study [published correction appears in Am J Gastroenterol. 2012;107(1):150] Am J Gastroenterol. 2011;107(1):89–95. [PMC free article] [PubMed] [Google Scholar]

5. Muto C.A., Pokrywka M., Shutt K. 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(3):273–280. [PubMed] [Google Scholar]

6. Pépin J., Valiquette L., Alary M.E. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004;171(5):466–472. [PMC free article] [PubMed] [Google Scholar]

7. Kelly C.P., LaMont J.T. Clostridium difficile: more difficult than ever [published correction appears in N Engl J Med. 2010;363(16):1585] N Engl J Med. 2008;359(18):1932–1940. [PubMed] [Google Scholar]

8. Ricciardi R., Rothenberger D.A., Madoff R.D., Baxter N.N. Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg. 2007;142(7):624–631. discussion 631. [PubMed] [Google Scholar]

9. Zilberberg M.D., Shorr A.F., Kollef M.H. Increase in Clostridium difficile-related hospitalizations among infants in the United States, 2000-2005. Pediatr Infect Dis J. 2008;27(12):1111–1113. [PubMed] [Google Scholar]

10. Zilberberg M.D., Shorr A.F., Kollef M.H. Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000-2005. Emerg Infect Dis. 2008;14(6):929–931. [PMC free article] [PubMed] [Google Scholar]

11. McDonald L.C., Owings M., Jernigan D.B. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006;12(3):409–415. [PMC free article] [PubMed] [Google Scholar]

12. McDonald L.C., Coignard B., Dubberke E., Ad Hoc Clostridium difficile Surveillance Working Group Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. 2007;28(2):140–145. [PubMed] [Google Scholar]

13. Cohen S.H., Gerding D.N., Johnson S., Society for Healthcare Epidemiology of America; Infectious Diseases Society of America Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) Infect Control Hosp Epidemiol. 2010;31(5):431–455. [PubMed] [Google Scholar]

14. Khanna S., Pardi D.S., Aronson S.L., Kammer P.P., Baddour L.M. Outcomes in community-acquired Clostridium difficile infection. Aliment Pharmacol Ther. 2012;35(5):613–618. [PMC free article] [PubMed] [Google Scholar]

15. Kim J., Smathers S.A., Prasad P., Leckerman K.H., Coffin S., Zaoutis T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006. Pediatrics. 2008;122(6):1266–1270. [PubMed] [Google Scholar]

16. Benson L., Song X., Campos J., Singh N. Changing epidemiology of Clostridium difficile-associated disease in children. Infect Control Hosp Epidemiol. 2007;28(11):1233–1235. [PubMed] [Google Scholar]

17. Enoch D.A., Butler M.J., Pai S., Aliyu S.H., Karas J.A. Clostridium difficile in children: colonisation and disease. J Infect. 2011;63(2):105–113. [PubMed] [Google Scholar]

18. Langley J.M., LeBlanc J.C., Hanakowski M., Goloubeva O. The role of Clostridium difficile and viruses as causes of nosocomial diarrhea in children. Infect Control Hosp Epidemiol. 2002;23(11):660–664. [PubMed] [Google Scholar]

19. Klein E.J., Boster D.R., Stapp J.R. Diarrhea etiology in a children's hospital emergency department: a prospective cohort study. Clin Infect Dis. 2006;43(7):807–813. [PubMed] [Google Scholar]

20. Boenning D.A., Fleisher G.R., Campos J.M., Hulkower C.W., Quinlan R.W. Clostridium difficile in a pediatric outpatient population. Pediatr Infect Dis. 1982;1(5):336–338. [PubMed] [Google Scholar]

21. Otten A.M., Reid-Smith R.J., Fazil A., Weese J.S. Disease transmission model for community-associated Clostridium difficile infection. Epidemiol Infect. 2010;138(6):907–914. [PubMed] [Google Scholar]

22. Viscidi R., Willey S., Bartlett J.G. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology. 1981;81(1):5–9. [PubMed] [Google Scholar]

23. MacCannell D.R., Louie T.J., Gregson D.B. Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada. J Clin Microbiol. 2006;44(6):2147–2152. [PMC free article] [PubMed] [Google Scholar]

24. Merrigan M., Venugopal A., Mallozzi M. Human hypervirulent Clostridium difficile strains exhibit increased sporulation as well as robust toxin production. J Bacteriol. 2010;192(19):4904–4911. [PMC free article] [PubMed] [Google Scholar]

25. Kuijper E.J., Barbut F., Brazier J.S. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill. 2008;13(31) pii:18942. [PubMed] [Google Scholar]

26. Kuijper E.J., Coignard B., Brazier J.S. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill. 2007;12(6):E1–E2. [PubMed] [Google Scholar]

27. Miller M., Gravel D., Mulvey M. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010;50(2):194–201. [PubMed] [Google Scholar]

28. Hubert B., Loo V.G., Bourgault A.M. 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. Clin Infect Dis. 2007;44(2):238–244. [PubMed] [Google Scholar]

29. Goorhuis A., Van der Kooi T., Vaessen N. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis. 2007;45(6):695–703. [PubMed] [Google Scholar]

30. Morgan O.W., Rodrigues B., Elston T. Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study. PLoS One. 2008;3(3):e1812. [PMC free article] [PubMed] [Google Scholar]

31. Thibault A., Miller M.A., Gaese C. Risk factors for the development of Clostridium difficile-associated diarrhea during a hospital outbreak. Infect Control Hosp Epidemiol. 1991;12(6):345–348. [PubMed] [Google Scholar]

32. Shah K., Pass L.A., Cox M., Lanham M., Arnold F.W. Evaluating contemporary antibiotics as a risk factor for Clostridium difficile infection in surgical trauma patients. J Trauma Acute Care Surg. 2012;72(3):691–695. [PubMed] [Google Scholar]

33. Rousseau C., Levenez F., Fouqueray C., Doré J., Collignon A., Lepage P. Clostridium difficile colonization in early infancy is accompanied by changes in intestinal microbiota composition. J Clin Microbiol. 2011;49(3):858–865. [PMC free article] [PubMed] [Google Scholar]

34. Rea M.C., O'Sullivan O., Shanahan F. Clostridium difficile carriage in elderly subjects and associated changes in the intestinal microbiota. J Clin Microbiol. 2012;50(3):867–875. [PMC free article] [PubMed] [Google Scholar]

35. Manges A.R., Labbe A., Loo V.G. Comparative metagenomic study of alterations to the intestinal microbiota and risk of nosocomial Clostridum difficile-associated disease. J Infect Dis. 2010;202(12):1877–1884. [PubMed] [Google Scholar]

36. Dethlefsen L., Relman D.A. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc Natl Acad Sci U S A. 2011;108(suppl 1):4554–4561. [PMC free article] [PubMed] [Google Scholar]

37. Mullane K.M., Miller M.A., Weiss K. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections [published correction appears in Clin Infect Dis. 2011;53(12):1312. Dosage error in article text] Clin Infect Dis. 2011;53(5):440–447. [PMC free article] [PubMed] [Google Scholar]

38. Dubberke E.R., Reske K.A., Noble-Wang J. Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities. Am J Infect Control. 2007;35(5):315–318. [PubMed] [Google Scholar]

39. Kim K.H., Fekety R., Batts D.H. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143(1):42–50. [PubMed] [Google Scholar]

40. Dubberke E.R., Gerding D.N., Classen D. Strategies to prevent Clostridium difficile infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(suppl 1):S81–S92. [PubMed] [Google Scholar]

41. Khanna S., Pardi D.S. IBD: Poor outcomes after Clostridium difficile infection in IBD. Nat Rev Gastroenterol Hepatol. 2012;9(6):307–308. [PubMed] [Google Scholar]

42. Ananthakrishnan A.N., McGinley E.L., Binion D.G. Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease. Gut. 2008;57(2):205–210. [PubMed] [Google Scholar]

43. Patriarchi F., Rolla M., Maccioni F. Clostridium difficile-related pancolitis in lung-transplanted patients with cystic fibrosis. Clin Transplant. 2011;25(1):E46–E51. [PubMed] [Google Scholar]

44. Kyne L., Sougioultzis S., McFarland L.V., Kelly C.P. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol. 2002;23(11):653–659. [PubMed] [Google Scholar]

45. Linsky A., Gupta K., Lawler E.V., Fonda J.R., Hermos J.A. Proton pump inhibitors and risk for recurrent Clostridium difficile infection [published correction appears in Arch Intern Med 2010;170(13):1100] Arch Intern Med. 2010;170(9):772–778. [PubMed] [Google Scholar]

46. Lowe D.O., Mamdani M.M., Kopp A., Low D.E., Juurlink D.N. Proton pump inhibitors and hospitalization for Clostridium difficile-associated disease: a population-based study. Clin Infect Dis. 2006;43(10):1272–1276. [PubMed] [Google Scholar]

47. Dial S., Delaney J.A., Schneider V., Suissa S. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ. 2006;175(7):745–748. [PMC free article] [PubMed] [Google Scholar]

48. Dial S., Delaney J.A., Barkun A.N., Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005;294(23):2989–2995. [PubMed] [Google Scholar]

49. Rao A., Jump R.L., Pultz N.J., Pultz M.J., Donskey C.J. In vitro killing of nosocomial pathogens by acid and acidified nitrite. Antimicrob Agents Chemother. 2006;50(11):3901–3904. [PMC free article] [PubMed] [Google Scholar]

50. Wilson K.H., Sheagren J.N., Freter R. Population dynamics of ingested Clostridium difficile in the gastrointestinal tract of the Syrian hamster. J Infect Dis. 1985;151(2):355–361. [PubMed] [Google Scholar]

51. Pépin J., Saheb N., Coulombe M.A. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41(9):1254–1260. [PubMed] [Google Scholar]

52. Khanna S., Aronson S.L., Kammer P.P., Baddour L.M., Pardi D.S. Gastric acid suppression and outcomes in Clostridium difficile infection: a population-based study. Mayo Clin Proc. 2012;87(7):636–642. [PMC free article] [PubMed] [Google Scholar]

53. Khanna S., Pardi D.S. Gastric acid suppression and Clostridium difficile infection: is there a causal connection [letter]? Clin Gastroenterol Hepatol. 2012;10(5):564. author reply 564. [PubMed] [Google Scholar]

54. Kufelnicka A.M., Kirn T.J. Effective utilization of evolving methods for the laboratory diagnosis of Clostridium difficile infection. Clin Infect Dis. 2011;52(12):1451–1457. [PubMed] [Google Scholar]

55. Carroll K.C. Tests for the diagnosis of Clostridium difficile infection: the next generation. Anaerobe. 2011;17(4):170–174. [PubMed] [Google Scholar]

56. Khanna S., Pardi D.S., Rosenblatt J.E., Patel R., Kammer P.P., Baddour L.M. An evaluation of repeat stool testing for Clostridium difficile infection by polymerase chain reaction . J Clin Gastroenterol. 2012 [published online ahead of print] [PubMed] [Google Scholar]

57. Sloan L.M., Duresko B.J., Gustafson D.R., Rosenblatt J.E. Comparison of real-time PCR for detection of the tcdC gene with four toxin immunoassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol. 2008;46(6):1996–2001. [PMC free article] [PubMed] [Google Scholar]

58. Peterson L.R., Mehta M.S., Patel P.A. Laboratory testing for Clostridium difficile infection: light at the end of the tunnel. Am J Clin Pathol. 2011;136(3):372–380. [PubMed] [Google Scholar]

59. Fujitani S., George W.L., Murthy A.R. Comparison of clinical severity score indices for Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011;32(3):220–228. [PubMed] [Google Scholar]

60. Lungulescu O.A., Cao W., Gatskevich E., Tlhabano L., Stratidis J.G. CSI: a severity index for Clostridium difficile infection at the time of admission. J Hosp Infect. 2011;79(2):151–154. [PubMed] [Google Scholar]

61. Zar F.A., Bakkanagari S.R., Moorthi K.M., Davis M.B. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45(3):302–307. [PubMed] [Google Scholar]

62. Belmares J., Gerding D.N., Parada J.P., Miskevics S., Weaver F., Johnson S. Outcome of metronidazole therapy for Clostridium difficile disease and correlation with a scoring system. J Infect. 2007;55(6):495–501. [PubMed] [Google Scholar]

63. Keddis M.T., Khanna S., Noheria A., Badour L.M., Pardi D.S., Qian Q. Clostridium difficile infection in patients with chronic kidney disease. Mayo Clin Proc. 2012 [In Press] [PMC free article] [PubMed] [Google Scholar]

64. Shivashankar R., Khanna S., Kammer P.P. Clinical predictors of severe complicated Clostridium difficile infection. Am J Gastroenterol. 2011;106(S2):S162. [Google Scholar]

65. Orenstein R., Aronhalt K.C., McManus J.E., Jr, Fedraw L.A. A targeted strategy to wipe out Clostridium difficile. Infect Control Hosp Epidemiol. 2011;32(11):1137–1139. [PubMed] [Google Scholar]

66. Pepin J., Alary M.E., Valiquette L. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005;40(11):1591–1597. [PubMed] [Google Scholar]

67. Musher D.M., Aslam S., Logan N. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005;40(11):1586–1590. [PubMed] [Google Scholar]

68. Gerber M., Ackermann G. OPT-80, a macrocyclic antimicrobial agent for the treatment of Clostridium difficile infections: a review. Exp Opin Investig Drugs. 2008;17(4):547–553. [PubMed] [Google Scholar]

69. Finegold S.M., Molitoris D., Vaisanen M.L., Song Y., Liu C., Bolaños M. In vitro activities of OPT-80 and comparator drugs against intestinal bacteria. Antimicrob Agents Chemother. 2004;48(12):4898–4902. [PMC free article] [PubMed] [Google Scholar]

70. Ackermann G., Löffler B., Adler D., Rodloff A.C. In vitro activity of OPT-80 against Clostridium difficile. Antimicrob Agents Chemother. 2004;48(6):2280–2282. [PMC free article] [PubMed] [Google Scholar]

71. Karlowsky J.A., Laing N.M., Zhanel G.G. In vitro activity of OPT-80 tested against clinical isolates of toxin-producing Clostridium difficile. Antimicrob Agents Chemother. 2008;52(11):4163–4165. [PMC free article] [PubMed] [Google Scholar]

72. Louie T.J., Miller M.A., Mullane K.M., OPT-80-003 Clinical Study Group Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422–431. [PubMed] [Google Scholar]

73. Cornely O.A., Crook D.W., Esposito R., OPT-80-004 Clinical Study Group [Collaborators (82)] Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. 2012;12(4):281–289. [PubMed] [Google Scholar]

74. Lancaster J.W., Matthews S.J. Fidaxomicin: the newest addition to the armamentarium against Clostridium difficile infections. Clin Ther. 2012;34(1):1–13. [PubMed] [Google Scholar]

75. Hu M.Y., Katchar K., Kyne L. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology. 2009;136(4):1206–1214. [PubMed] [Google Scholar]

76. Johnson S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect. 2009;58(6):403–410. [PubMed] [Google Scholar]

77. Gough E., Shaikh H., Manges A.R. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. 2011;53(10):994–1002. [PubMed] [Google Scholar]

78. Hamilton M.J., Weingarden A.R., Sadowsky M.J., Khoruts A. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol. 2012;107(5):761–767. [PubMed] [Google Scholar]

79. Mattila E., Uusitalo-Seppälä R., Wuorela M. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology. 2012;142(3):490–496. [PubMed] [Google Scholar]

80. Kassam Z., Hundal R., Marshall J.K., Lee C.H. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med. 2012;172(2):191–193. [PubMed] [Google Scholar]

81. Bakken J.S., Borody T., Brandt L.J., Fecal Microbiota Transplantation Workgroup Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol. 2011;9(12):1044–1049. [PMC free article] [PubMed] [Google Scholar]

82. Koo H.L., DuPont H.L. Rifaximin: a unique gastrointestinal-selective antibiotic for enteric diseases. Curr Opin Gastroenterol. 2010;26(1):17–25. [PMC free article] [PubMed] [Google Scholar]

83. DuPont H.L., Jiang Z.D., Okhuysen P.C. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers' diarrhea [published correction appears in Ann Intern Med. 2005;143(3):239] Ann Intern Med. 2005;142(10):805–812. [PubMed] [Google Scholar]

84. Berman A.L. Efficacy of rifaximin and vancomycin combination therapy in a patient with refractory Clostridium difficile-associated diarrhea. J Clin Gastroenterol. 2007;41(10):932–933. [PubMed] [Google Scholar]

85. Johnson S., Schriever C., Galang M., Kelly C.P., Gerding D.N. Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis. 2007;44(6):846–848. [PubMed] [Google Scholar]

86. Rubin D.T., Sohi S., Glathar M., Thomas T., Yadron N., Surma B.L. Rifaximin is effective for the treatment of Clostridium difficile-associated diarrhea: results of an open-label pilot study. Gastroenterol Res Pract. 2011;2011:106978. [PMC free article] [PubMed] [Google Scholar]

87. Pardi D.S., Brennan R., Spinnell M. The efficacy and safety of rifaximin vs. vancomycin in the treatment of mild to moderate C. difficile infection: a randomized double-blind active comparator trial. Gastroenterology. 2012;142(5):S-599. [Google Scholar]

88. Garey K.W., Ghantoji S.S., Shah D.N. A randomized, double-blind, placebo-controlled pilot study to assess the ability of rifaximin to prevent recurrent diarrhoea in patients with Clostridium difficile infection. J Antimicrob Chemother. 2011;66(12):2850–2855. [PubMed] [Google Scholar]

89. Musher D.M., Logan N., Bressler A.M., Johnson D.P., Rossignol J.F. Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study. Clin Infect Dis. 2009;48(4):e41–e46. [PubMed] [Google Scholar]

90. Musher D.M., Logan N., Hamill R.J. Nitazoxamide for the treatment of Clostridium difficile colitis [letter] Clin Infect Dis. 2006;43(4):421–427. [PubMed] [Google Scholar]Young J.D., Mangino E., Stevenson K.B., Koletar S.L. Nitazoxanide versus metronidazole for Clostridium difficile-associated colitis [letter] Clin Infect Dis. 2007;44(1):152. author reply 152-154. [PubMed] [Google Scholar]

91. Taylor N.S., Bartlett J.G. Binding of Clostridium difficile cytotoxin and vancomycin by anion-exchange resins. J Infect Dis. 1980;141(1):92–97. [PubMed] [Google Scholar]

92. Abougergi M.S., Broor A., Cui W., Jaar B.G. Intravenous immunoglobulin for the treatment of severe Clostridium difficile colitis: an observational study and review of the literature. J Hosp Med. 2010;5(1):E1–E9. [PubMed] [Google Scholar]

93. Leav B.A., Blair B., Leney M. Serum anti-toxin B antibody correlates with protection from recurrent Clostridium difficile infection (CDI) Vaccine. 2010;28(4):965–969. [PubMed] [Google Scholar]

94. Abougergi M.S., Kwon J.H. Intravenous immunoglobulin for the treatment of Clostridium difficile infection: a review. Dig Dis Sci. 2011;56(1):19–26. [PubMed] [Google Scholar]

95. Lowy I., Molrine D.C., Leav B.A. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med. 2010;362(3):197–205. [PubMed] [Google Scholar]

96. Kotloff K.L., Wasserman S.S., Losonsky G.A. Safety and immunogenicity of increasing doses of a Clostridium difficile toxoid vaccine administered to healthy adults. Infect Immun. 2001;69(2):988–995. [PMC free article] [PubMed] [Google Scholar]

97. Sougioultzis S., Kyne L., Drudy D. Clostridium difficile toxoid vaccine in recurrent C. difficile-associated diarrhea. Gastroenterology. 2005;128(3):764–770. [PubMed] [Google Scholar]

98. Greenberg R.N., Marbury T.C., Foglia G., Warny M. Phase I dose finding studies of an adjuvanted Clostridium difficile toxoid vaccine. Vaccine. 2012;30(13):2245–2249. [PubMed] [Google Scholar]

99. Dendukuri N., Costa V., McGregor M., Brophy J.M. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review [published correction appears in CMAJ. 2005;173(4):345] CMAJ. 2005;173(2):167–170. [PMC free article] [PubMed] [Google Scholar]

100. Castagliuolo I., Riegler M.F., Valenick L., LaMont J.T., Pothoulakis C. Saccharomyces boulardii protease inhibits the effects of Clostridium difficile toxins A and B in human colonic mucosa. Infect Immun. 1999;67(1):302–307. [PMC free article] [PubMed] [Google Scholar]

101. Surawicz C.M., McFarland L.V., Elmer G., Chinn J. Treatment of recurrent Clostridium difficile colitis with vancomycin and Saccharomyces boulardii. Am J Gastroenterol. 1989;84(10):1285–1287. [PubMed] [Google Scholar]

102. Surawicz C.M., McFarland L.V., Greenberg R.N. The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis. 2000;31(4):1012–1017. [PubMed] [Google Scholar]

103. Longo W.E., Mazuski J.E., Virgo K.S., Lee P., Bahadursingh A.N., Johnson F.E. Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum. 2004;47(10):1620–1626. [PubMed] [Google Scholar]

104. Markelov A., Livert D., Kohli H. Predictors of fatal outcome after colectomy for fulminant Clostridium difficile colitis: a 10-year experience. Am Surg. 2011;77(8):977–980. [PubMed] [Google Scholar]

105. Byrn J.C., Maun D.C., Gingold D.S., Baril D.T., Ozao J.J., Divino C.M. Predictors of mortality after colectomy for fulminant Clostridium difficile colitis. Arch Surg. 2008;143(2):150–154. discussion 155. [PubMed] [Google Scholar]

106. Neal M.D., Alverdy J.C., Hall D.E., Simmons R.L., Zuckerbraun B.S. Diverting loop ileostomy and colonic lavage: an alternative to total abdominal colectomy for the treatment of severe, complicated Clostridium difficile associated disease. Ann Surg. 2011;254(3):423–427. discussion 427-429. [PubMed] [Google Scholar]

107. Synnott K., Mealy K., Merry C., Kyne L., Keane C., Quill R. Timing of surgery for fulminating pseudomembranous colitis. Br J Surg. 1998;85(2):229–231. [PubMed] [Google Scholar]

108. Hall J.F., Berger D. Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg. 2008;196(3):384–388. [PubMed] [Google Scholar]

109. Ali S.O., Welch J.P., Dring R.J. Early surgical intervention for fulminant pseudomembranous colitis. Am Surg. 2008;74(1):20–26. [PubMed] [Google Scholar]

110. Seder C.W., Villalba M.R., Jr, Robbins J. Early colectomy may be associated with improved survival in fulminant Clostridium difficile colitis: an 8-year experience. Am J Surg. 2009;197(3):302–307. [PubMed] [Google Scholar]


Page 2

Established and Emerging Risk Factors for Clostridium difficile Infection

Age >65 y
Previous hospitalization and prolonged length of hospital stay
Nursing home or long-term care facility residence
Contact with active carriers
Antibiotic exposure
 Increased risk with prolonged use or multiple antibiotics
Consumption of processed meat
Previous gastrointestinal surgery or endoscopic procedure
Presence of comorbid conditions
Malignancy and chemotherapy
Cystic fibrosis
Diabetes mellitus
Liver cirrhosis
Chronic kidney disease
Inflammatory bowel disease
Immunosuppression, immunodeficiency, or human immunodeficiency virus
Malnutrition
Hypoalbuminemia
Use of proton pump inhibitors
Solid organ or hematopoietic stem cell transplantation
Presence of gastrostomy or jejunostomy tube