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Copyright © 2005 Massachusetts Medical Society. All rights reserved. Downloaded from www.nejm.org on December 2, 2005 . For personal use only. No other uses without permission. The new england journal o f medicine n engl j med 353;23 www.nejm.org december 8, 2005

1. Viscidi R, Willey S, Bartlett JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology 1981;81:5-9.
2. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320:204-10.
3. Tedesco FJ, Barton RW, Alpers DH. Clindamycin-associated colitis: a prospective study. Ann Intern Med 1974;81:429-33.
4. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med 1978;298:531-4.
5. Chang TW, Laurermann M, Bartlett JG. Cytotoxicity assay in antibiotic-associated colitis. J Infect Dis 1979;140:765-70.
6. Pepin J, Saheb N, Coulombe MA, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficileassociated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254-60.
7. Pepin J, Valiquette L, Alary ME, et al. Clostridium difficileassociated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466-72.
8. 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;26:273-80.
9. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene–variant strain of Clostridium difficile. N Engl J Med 2005;353:2433-41.
10. 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;40:3470-5.
11. 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; 366:1079-84.
12. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med 2005; 353:2442-9. Copyright © 2005 Massachusetts Medical Society.

1 posted on 12/02/2005 2:11:14 PM PST by neverdem
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To: neverdem

What a crappy topic.


2 posted on 12/02/2005 2:20:33 PM PST by GSlob
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To: sefarkas; epow; Judith Anne; Mother Abigail; PatrickHenry; AntiGuv
This new strain has a deletion which if present normally seems to suppress toxin production.

This hypothesis is supported by recent studies showing that this C. difficile strain produces 16 to 23 times more toxins A and B in vitro than do other strains.11

3 posted on 12/02/2005 2:20:41 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

C. diff is becoming a serious problem, especially among the nursing home communities. My grandmother died this past summer from C.diff related complications. Before that, I've never heard of C.diff. Thanks for posting this article.


5 posted on 12/02/2005 2:23:33 PM PST by toothfairy86
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To: neverdem
Stupid,ignorant Americans simply will not accept certain things about their health and the US heath care system.Among them are:

Just because you get hit on the head with a wiffle ball,it's unlikely that you need a Neurosurgeon.

Just because you have an earache at 2AM,it doesn't mean that you should call 911 to take you to an Emergency Room.

Just because you have the sniffles,it doesn't mean that you need an antibiotic.

Spineless physicians and selfish patientsare largely responsible for drug resistant bacteria in this country.

6 posted on 12/02/2005 3:32:01 PM PST by Gay State Conservative
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To: MedicalMess

ping


8 posted on 12/03/2005 7:46:10 AM PST by MamaLucci (Mutually assured destruction STILL keeps the Clinton administration criminals out of jail.)
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