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Table 1 Prior NICU studies examining C. difficile prevalence

From: Clostridium difficile stool shedding in infants hospitalized in two neonatal intensive care units is lower than previous point prevalence estimates using molecular diagnostic methods

Author, Year of Study Location Test Methods Prevalence of C. difficile
Kim, 1981 [37] U.S. Culture + cytotoxicity assay 21% culture +, 14% toxin +
Blakey, 1982 [31] Australia Culture 0–35% culture +a
Donta, 1982 [18] U.S. Cytotoxicity assay 54.9% toxin +
Sherertz, 1982 [25] U.S. Culture 59% culture +
Malamou-Ladas, 1983 [39] England Culture 54% culture +
Al-Jumaili, 1984 [13] England Culture + cytotoxicity assay 71% culture +, 45% toxin +
Lishman, 1984 [38] England Culture + cytotoxicity assay 78% culture +, 67% toxin +
Phua, 1984 [40] England Culture + cytotoxicity assay 21% culture +, 0% toxin +
Zedd, 1984 [42] U.S. Culture 41% culture +
Cardines, 1988 [32] Italy Culture + cytotoxicity assay + PAGEb 63% culture +, 0% toxin + (per cytotoxicity assay), 16% toxigenic strain + (per PAGE)
el-Mohandes, 1993 [34] U.S. Culture + cytotoxicity assay 15–33% culture +, 71–100% toxin +c
Kato, 1994 [36] Japan Culture + PCR for toxins A and B 61% culture +, 6% toxin +d
Tina, 1994 [41] Italy Culture + EIA for toxins A and B 43.6% culture +, 31.2% toxin +
Enad, 1997 [19] U.S. EIA for toxin A 52% EIA +
Alfa, 2002 [30] Canada PCR for C. difficile 16S gene 21% C. difficile 16S gene +
Chang, 2012 [33] Korea PCR for C. difficile 16S gene
+ PCR for toxins A and B
34.7–53.1% C. difficile 16S gene+e
23.5–30.8% toxin +
Ferraris, 2012 [35] France PCR for C. difficile 16S gene 42.1% C. difficile 16S gene+
Faden, 2015 [20] U.S. EIA GDH Ag/toxins A/B
C. difficile culture
25.7% +f
  1. aStudy measured prevalence at days 0–4, 5–8, 9–12, 13–16, 17–20 and > 20 days, thus providing a prevalence range
  2. bSDS-polyacrylamide gel electrophoresis (PAGE) of EDTA-extracted proteins used to identify toxigenic strains
  3. cStudy measured prevalence after 1 week of enteral feeding, at 15 +/− 1 days of life; 2 more specimens were collected at 2 week intervals, 24 +/− 1 and 32 +/− 2 days of life, thus providing a prevalence range
  4. dPCR for toxins A and B were performed on only 32 of 41 C. difficile culture+ infants
  5. eStudy measured prevalence within 72 h of birth, 1, 2, and 4–6 weeks of age thus providing a prevalence range
  6. fTest modality of positivity unspecified