Over the last years major advances have been made in the field of C. difficile research. Despite the continuous progress of research in C. difficile epidemiology and molecular biology. This thesis... Show moreOver the last years major advances have been made in the field of C. difficile research. Despite the continuous progress of research in C. difficile epidemiology and molecular biology. This thesis shows that the development of molecular based techniques in detecetion and typing of C. difficile could be very valuable in combatting CDI. This also applies for the genetics and molecular biology of C. difficile in understanding the virulence of C. difficile. However, the continuing development of new techniques, both typing and genetics manipulation tools, has also led to the recognition of potential weaknesses of the currently frequent used techniques. Therefore, it is of utmost importance to keep up with the technical progress in the field of C. difficile research to enable further elucidation of the mechanisms that determine the virulence of C. difficile. Show less
Clostridium difficile is a spore-forming bacterium, the toxin-producing strains of which cause colitis. Risk factors are antibiotics, advanced age and severe comorbidity. C. difficile infection ... Show moreClostridium difficile is a spore-forming bacterium, the toxin-producing strains of which cause colitis. Risk factors are antibiotics, advanced age and severe comorbidity. C. difficile infection (CDI) has been regarded as mostly a hospital-acquired infection. Preventing relapses is considered the biggest challenge in CDI management. In this thesis, we show that CDI occurs in Dutch general practices, often in patients without contact with hospitals. Also, we show that the emerging virulent strain PCR ribotype 027 has not become dominant in European hospitals, but community-associated type 078 has become highly prevalent. Furthermore, we found that cystic fibrosis outpatients are frequently colonized with C. difficile, though mostly with nonpathogenic strains. Thus, acquisition of C. difficile in the community appears more important than previously thought. Next, we show that renal failure at the time of diagnosis predicts relapses. In addition, patients who fail to develop antibodies against C. difficile toxins have a higher chance of relapse. We describe an experimental product derived from the milk of cows vaccinated against C. difficile and its toxins, which might prevent relapses. The last part of the thesis consists of the European guideline for CDI treatment and its recent update Show less
This thesis is a combination of traumatic and non-traumatic events in the abdomen, and the optimization of treatment in both entities. The first part describes the very prevalent infection caused... Show moreThis thesis is a combination of traumatic and non-traumatic events in the abdomen, and the optimization of treatment in both entities. The first part describes the very prevalent infection caused by the bacterium Clostridium difficile. The colitis caused by this infection can be severe and complicated, resulting in high morbidity and mortality. The studies show that by early diagnosis, improved logistics and conservative antibiotic management, treatment can be optimized. In the second part of the thesis, severe trauma to the abdomen is described. In severe renal and liver injuries, as well as in injuries to the pancreatoduodenal complex we show that a more conservative approach is possible, instead of an invasive, surgical treatment. If the clinical situation permits it, even the most severe injuries to the abdomen can be managed without an operation. Additionally we conclude that improved logistics around this specific patient population will be necessary in further optimizing outcomes. Show less
