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

Table 1 Prior NICU studies examining C. difficile prevalence

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 + PAGE^b	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

^aStudy measured prevalence at days 0–4, 5–8, 9–12, 13–16, 17–20 and > 20 days, thus providing a prevalence range
^bSDS-polyacrylamide gel electrophoresis (PAGE) of EDTA-extracted proteins used to identify toxigenic strains
^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
^dPCR for toxins A and B were performed on only 32 of 41 C. difficile culture+ infants
^eStudy measured prevalence within 72 h of birth, 1, 2, and 4–6 weeks of age thus providing a prevalence range
^fTest modality of positivity unspecified

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