Aims: The current study aimed to isolate and characterize bacterial strains associated diarrhea with the focus on Enterobacter species strains and test for susceptibility to antibiotics. Methodology and results: A total of 400 stool samples from inpatients suffering from diarrhea in Al-Qasim Hospital at Al-Hilla City of Iraq were screened form January 2018 to January 2019. Phenotypic, molecular, and biochemical methods were used to identify the isolated bacteria. A new strain of Enterobacter hormaechei was obtained from two stool samples of inpatients suffering from diarrhea for more than two weeks. This strain is Gram negative, rod shaped, and facultative anaerobic. Multiple sequence alignment analysis and phylogenetic tree construction of the sequenced 16S rRNA gene of the isolated strain suggested that this strain can be identified as E. hormaechei subsp. xiangfangensis, named as E. hormaechei subsp. xiangfangensis strain AA1. This strain was resistant to augmentin, ampicillin, cephalothin, cefoxitin, ceftazidime, cefixime, ticracillin/clavulanic acid, cefotaxime, streptomycin, erythromycin, amikacin, ciprofloxacin, and chloramphenicol, while it was susceptible to meropenem along with imipenem. Conclusion, significance and impact of study In the present study, E. hormaechei subsp xiangfangensis was isolated for the first time in Iraq and was resistant to most of the tested antibiotics, making it an etiologic agent that is not easy to be treated.
Diarrhea--microbiology

BACKGROUND: Irritable bowel syndrome (IBS) is reported associated with the alteration of gut microbial composition termed as dysbiosis. However, the pathogenic mechanism of IBS remains unclear, while the studies of Chinese individuals are scarce. This study aimed to understand the concept of dysbiosis among patients with Chinese diarrhea-predominant IBS (IBS-D), as a degree of variance between the gut microbiomes of IBS-D population and that of a healthy population. METHODS: The patients with IBS-D were recruited (assessed according to the Rome III criteria, by IBS symptom severity score) from the Outpatient Department of Gastroenterology of Peking University Third Hospital, and volunteers as healthy controls (HCs) were enrolled, during 2013. The 16S rRNA sequences were extracted from fecal samples. Ribosomal database project resources, basic local alignment search tool, and SparCC software were used to obtain the phylotype composition of samples and the internal interactions of the microbial community. Herein, the non-parametric test, Wilcoxon rank-sum test was carried out to find the statistical significance between HC and IBS-D groups. All the P values were adjusted to q values to decrease the error rate. RESULTS: The study characterized the gut microbiomes of Chinese patients with IBS-D, and demonstrated that the dysbiosis could be characterized as directed alteration of the microbiome composition leading to greater disparity between relative abundance of two phyla, Bacteroidetes (Z = 4.77, q = 1.59 × 10) and Firmicutes (Z = -3.87, q = 5.83 × 10). Moreover, it indicated that the IBS symptom features were associated with the dysbiosis of whole gut microbiome, instead of one or several certain genera even they were dominating. Two genera, Bacteroides and Lachnospiracea incertae sedis, were identified as the core genera, meanwhile, the non-core genera contribute to a larger pan-microbiome of the gut microbiome. Furthermore, the dysbiosis in patients with IBS-D was associated with a reduction of network complexity of the interacted microbial community (HC vs. IBS-D: 639 vs. 154). The disordered metabolic functions of patients with IBS-D were identified as the potential influence of gut microbiome on the host (significant difference with q < 0.01 between HC and IBS-D). CONCLUSIONS This study supported the view of the potential influence of gut microbiome on the symptom of Chinese patients with IBS-D, and further characterized dysbiosis in Chinese patients with IBS-D, thus provided more pathological evidences for IBS-D with the further understanding of dysbiosis.
Diarrhea ; microbiology ; Dysbiosis ; microbiology ; Feces ; microbiology ; Gastrointestinal Microbiome ; genetics ; Humans ; Irritable Bowel Syndrome ; microbiology ; Models, Theoretical ; RNA, Ribosomal, 16S ; genetics

Calf diarrhea is a commonly reported disease in young animals, and still a major cause of productivity and economic loss to cattle producers worldwide. In the report of the 2007 National Animal Health Monitoring System for U.S. dairy, half of the deaths among unweaned calves was attributed to diarrhea. Multiple pathogens are known or postulated to cause or contribute to calf diarrhea development. Other factors including both the environment and management practices influence disease severity or outcomes. The multifactorial nature of calf diarrhea makes this disease hard to control effectively in modern cow-calf operations. The purpose of this review is to provide a better understanding of a) the ecology and pathogenesis of well-known and potential bovine enteric pathogens implicated in calf diarrhea, b) describe diagnostic tests used to detect various enteric pathogens along with their pros and cons, and c) propose improved intervention strategies for treating calf diarrhea.
Animals ; Cattle ; *Cattle Diseases/diagnosis/drug therapy/microbiology/prevention & control ; Diarrhea/diagnosis/microbiology/prevention & control/*veterinary

Aged, 80 and over ; Diarrhea ; microbiology ; Enterobacteriaceae ; isolation & purification ; Feces ; microbiology ; Female ; Humans

OBJECTIVEThe aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.

METHODSWe analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.

RESULTSOut of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.

CONCLUSIONSOur results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.

Clostridium difficile ; Diarrhea ; epidemiology ; microbiology ; Enterocolitis, Pseudomembranous ; epidemiology ; Humans ; Neoplasms ; epidemiology ; microbiology ; Risk Factors

Diarrhea ; epidemiology ; microbiology ; Humans ; Infant ; Salmonella Infections ; epidemiology ; microbiology ; Salmonella typhimurium

Methicillin resistant Staphylococcal aureus (MRSA) enterocolitis is characterized by high fever, abdominal distension, and watery diarrhea that leads to severe dehydration, shock, a sharp decrease in the white cell counts and sometimes multiple organ failure. Clinically, it can be an another cause of nosocomial diarrhea. If MRSA enteritis is suspected from the clinical symptoms, prompt treatment and strict prophylactic measures including vancomycin, are most important for its management. We recently observed a case of MRSA enterocolitis as a nosocomial infection in a patient with acute pancreatitis. This patient showed uncontrolled massive diarrhea, fever, and multiple organ failure. We report a case of MRSA enterocolitis with a review of literatures.
Cross Infection/diagnosis/*microbiology ; Diarrhea/etiology/*microbiology ; Enterocolitis/complications/diagnosis/*microbiology ; Humans ; Male ; *Methicillin Resistance ; Middle Aged ; *Staphylococcal Infections/diagnosis

To characterize rotavirus G and P genotypes circulating among infants and young children hospitalized with severe diarrhea in a university hospital in Gyeonggi province, Korea, and to examine any association of the genotypes and nosocomial infections, we genotyped 103 isolates of rotavirus by multiplex RT-PCR. In July 2001-June 2002, we found that globally common strains constituted 64.2% (G2P[4] 28.3%, G3P[8] 28.3%, G4P[8] 5.7%, and G1P[8] 1.9%), and the uncommon strain, G4P[6], constituted 26.4%. During July 2002-June 2003, the percentage of common strains decreased to 44.0% (G3P[8] 18.0%, G2P[4] 16.8%, and G1P[8] 10.0%), but G4P[6] increased to 36.0%. G9P[8] was identified in 10.0% of cases, and thus can be considered an emerging strain in Korea. Eight-eight percent of G4P[6] was isolated from newborn babies. Among the 103 patients, there was an evidence of nosocomial rotavirus infection in 23 children (22.3%). Of these, 19 (82.6%) were newborns infected with G4P[6] strains of rotavirus. Most of the children who acquired rotavirus infection nosocomially showed symptoms of diarrhea, vomiting, fever, poor sucking, or dehydration, regardless of the genotype. This study revealed that G4P[6] has been the major genotype causing nosocomial rotavirus infection in our hospital.
Rotavirus Infections/classification/*microbiology ; Rotavirus/*classification/*genetics ; Male ; Infant ; Humans ; Genotype ; Feces/microbiology ; Diarrhea/*microbiology ; Cross Infection/classification/*microbiology ; Child, Preschool

To characterize rotavirus G and P genotypes circulating among infants and young children hospitalized with severe diarrhea in a university hospital in Gyeonggi province, Korea, and to examine any association of the genotypes and nosocomial infections, we genotyped 103 isolates of rotavirus by multiplex RT-PCR. In July 2001-June 2002, we found that globally common strains constituted 64.2% (G2P[4] 28.3%, G3P[8] 28.3%, G4P[8] 5.7%, and G1P[8] 1.9%), and the uncommon strain, G4P[6], constituted 26.4%. During July 2002-June 2003, the percentage of common strains decreased to 44.0% (G3P[8] 18.0%, G2P[4] 16.8%, and G1P[8] 10.0%), but G4P[6] increased to 36.0%. G9P[8] was identified in 10.0% of cases, and thus can be considered an emerging strain in Korea. Eight-eight percent of G4P[6] was isolated from newborn babies. Among the 103 patients, there was an evidence of nosocomial rotavirus infection in 23 children (22.3%). Of these, 19 (82.6%) were newborns infected with G4P[6] strains of rotavirus. Most of the children who acquired rotavirus infection nosocomially showed symptoms of diarrhea, vomiting, fever, poor sucking, or dehydration, regardless of the genotype. This study revealed that G4P[6] has been the major genotype causing nosocomial rotavirus infection in our hospital.
Rotavirus Infections/classification/*microbiology ; Rotavirus/*classification/*genetics ; Male ; Infant ; Humans ; Genotype ; Feces/microbiology ; Diarrhea/*microbiology ; Cross Infection/classification/*microbiology ; Child, Preschool

BACKGROUND: Antimicrobial susceptibility testing (AST) of Clostridium difficile is increasingly important because of the rise in resistant strains. The standard medium for the AST of C. difficile is supplemented Brucella agar (sBA), but we found that the growth of C. difficile on sBA was not optimal. Because active growth is critical for reliable AST, we developed a new, modified C. difficile (mCD) agar. C. difficile grew better on mCD agar than on sBA. METHODS: C. difficile isolates were collected from patients with healthcare-associated diarrhea. sBA medium was prepared according to the CLSI guidelines. Homemade mCD agar containing taurocholate, L-cysteine hydrochloride, and 7% horse blood was used. For 171 C. difficile isolates, we compared the agar dilution AST results from mCD agar with those from sBA. RESULTS: No significant differences were observed in the 50% minimal inhibitory concentration (MIC50) and 90% minimal inhibitory concentration (MIC90) of clindamycin (CLI), metronidazole (MTZ), moxifloxacin (MXF), piperacillin-tazobactam (PTZ), and rifaximin (RIX), but the values for vancomycin (VAN) were two-fold higher on mCD agar than on sBA. The MICs of CLI, MXF, and RIX were in 100% agreement within two-fold dilutions, but for MTZ, VAN, and PTZ, 13.7%, 0.6%, and 3.1% of the isolates, respectively, were outside the acceptable range. CONCLUSIONS: The MIC ranges, MIC50 and MIC90, were acceptable when AST was performed on mCD agar. Thus, mCD agar could be used as a substitute medium for the AST of C. difficile.
Anti-Infective Agents/*pharmacology ; Clostridium Infections/microbiology ; Clostridium difficile/*drug effects/isolation & purification ; Diarrhea/*microbiology ; Humans ; Microbial Sensitivity Tests/*methods