Clostridium difficile-associated diarrhea (CAD) is a very common nosocomial infection that contributes significantly to patient morbidity and mortality as well as to the cost of hospitalization. Previously, strains of toxin A-negative, toxin B-positive C. difficile were not thought to be associated with clinically significant disease. This study reports the characterization of a toxin A-negative, toxin B-positive strain ofC. difficile that was responsible for a recently described nosocomial outbreak of CAD. Analysis of the seven patient isolates from the outbreak by pulsed-field gel electrophoresis indicated that this outbreak was due to transmission of a single strain of C. difficile. Our characterization of this strain (HSC98) has demonstrated that the toxin A gene lacks 1.8 kb from the carboxy repetitive oligopeptide (CROP) region but apparently has no other major deletions from other regions of the toxin A or toxin B gene. The remaining 1.3-kb fragment of the toxin A CROP region from strain HSC98 showed 98% sequence homology with strain 1470, previously reported by M. Weidmann in 1997 (GenBank accession number Y12616), suggesting that HSC98 is toxinotype VIII. The HSC98 strain infecting patients involved in this outbreak produced the full spectrum of clinical illness usually associated with C. difficile-associated disease. This pathogenic spectrum was manifest despite the inability of this strain to alter tight junctions as determined by using in vitro tissue culture testing, which suggested that no functional toxin A was produced by this strain.

Balantidium coli, a ciliated protozoan, is well known to cause intestinal infection in humans. Extraintestinal spread to the peritoneal cavity and genitourinary tract has rarely been reported. There have also been a few cases of lung involvement from this parasite. A case of B coli causing a thick-walled right upper lobe cavity in an organic farmer who had contact with aerosolized pig manure is reported. Bronchoalveolar lavage fluid examined for ova and parasite revealed trophozoites of B coli in large numbers. Treatment with doxycycline hyclate led to marked improvement. Necrotizing lung infection caused by the protozoan B coli should be considered in individuals who report contact with pigs.

Complicated intra-abdominal infections (IAIs) remain a major challenge in clinical practice. In addition to significant morbidity and mortality for patients, they consume substantial hospital resources. This is compounded by the potential misuse of antimicrobial agents that may result in suboptimal treatment, as well as encourage the selection and spread of antibiotic-resistant microorganisms in the health care setting. The present guideline was developed jointly by the Canadian Surgical Society (CSS) and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada. The primary goal was to provide updated recommendations for the medical and surgical management of complicated IAIs since publication of the 2003 antimicrobial treatment guideline by the Infectious Diseases Society of America (IDSA) (1). Particular focus is directed at risk stratification for poor outcome based on epidemiological studies, current status of antimicrobial susceptibility and resistance profiles among enteric pathogens, therapeutic efficacy of antimicrobial regimens based on randomized clinical trials, operative versus percutaneous approaches for source control, the role of intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in IAI, and infection control and preventive measures for postoperative IAIs and surgical site infections. An additional objective is to categorize the recommendations according to the strength and quality of the available evidence using a standardized grading system. Importantly, the current guideline provides recommendations for initial empirical antimicrobial management of complicated IAIs based on clinical settings and issues unique to the Canadian health care system.Summarized below are the key evidence-based recommendations grouped according to the main sections discussed in more detail in the guideline. Each recommendation is rated by the strength of support (category A to C) and quality of evidence (grade 1 to 3) as assessed by the working group of the guideline. Key recommendations for risk assessment and stratificationRecommendation 1. Categorize the severity of illness by using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score: low-moderate (lower than 15) or high (15 or greater) (A-2 evidence). Although the APACHE II scoring is infrequently used clinically outside of the critical care setting at present, it is recommended that physicians and surgeons consider introducing it into clinical use in patients with IAIs. A user-friendly APACHE II calculator can be found on the following Web site . Recommendation 2. Identify high-risk patients for poor outcome by stratification according to community-acquired versus health care-associated IAIs, previous antibiotic exposure, and underlying comorbid conditions such as diabetes, severe cardiopulmonary disease or immunosuppression (A-2 evidence) Recommendation 3. Use the severity of illness score (APACHE II) and other risk factors outlined above to plan appropriate medical or ...

Background: An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.