Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: results of a one-year study.

Introduction: Determining the cause of community-acquired pneumonia (CAP) remains problematic. In this observational study, we systematically applied currently approved diagnostic techniques in patients hospitalized for CAP in order to determine the proportion in which an etiological agent could be identified.

Methods: All patients admitted with findings consistent with CAP were included.

Bacteraemia from an unrecognized source (occult bacteraemia) occurring during Clostridium difficile infection.

Background: The purpose of this investigation was to determine if disruption of the colonic epithelium during Clostridium difficile infection (CDI) is associated with bacteraemia due to secondary bacterial invasion by enteric organisms.

Methods: We reviewed the medical records of 505 randomly selected individuals from a database of patients who tested positive for C. difficile toxin and identified bacteraemias that occurred in 2 periods-the pre-CDI and post-CDI periods.

Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study.

Background: Vancomycin is the only US Food and Drug Administration-approved drug for treatment of Clostridium difficile infection (CDI). Metronidazole has been widely used for this purpose but may be inferior to vancomycin, especially for hospitalized patients with severe disease. We report a prospective, double-blind, randomized controlled trial comparing nitazoxanide with vancomycin for treatment of CDI.

Detection of Clostridium difficile toxin: comparison of enzyme immunoassay results with results obtained by cytotoxicity assay.

Several kinds of laboratory techniques are available to detect Clostridium difficile toxin in fecal samples. Because questions have been raised about the reliability of immunoassays compared to the accepted standard, cytotoxicity assay, we studied three enzyme immunoassays (EIAs) and one rapid EIA, which demonstrated relatively good sensitivities and specificities compared to cytotoxicity assay.

Clostridium difficile colitis that fails conventional metronidazole therapy: response to nitazoxanide.

Objectives: Clostridium difficile-associated disease has increased in incidence and severity. Recommended treatments include metronidazole and vancomycin. Recent investigations, however, document the failure of metronidazole to cure a substantial proportion of patients with Clostridium difficile colitis, but oral administration of vancomycin raises concerns over selection of antibiotic-resistant organisms in the hospital environment.

Nitazoxanide for the treatment of Clostridium difficile colitis.

Background: Clostridium difficile colitis has increased in incidence and severity, and treatment failure with metronidazole therapy has increasingly been documented. It is uncertain whether treatment with vancomycin is more effective than treatment with metronidazole, but concern over the emergence of vancomycin resistance has motivated the search for alternative therapy. Nitazoxanide, a nitrothiazolide, blocks anaerobic metabolism of eukaryocyes and effectively treats intestinal infestation due to Cryptosporidium or Giardia species.

Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole.

Background: Clostridium difficile is a frequent cause of serious nosocomial infection. Earlier reports have suggested that treatment with metronidazole cured nearly 90% of patients, with only a modest rate of recurrence of infection. In recent years, the rate of response to treatment with this drug has appeared to be much lower.