Appendix. C difficile in Neonatal Intensive Care Unit Patients: A Systematic Review

Appendix. C. difficile in NICU Patients: A systematic Review – Print Version Cdc-pdf[PDF – 4 pages].

1. Primary Search Strategies

Table 1. MEDLINE® Search Strategy

Order of search, Medline search terms, and number of results for each search.
# Search History Results
1 exp Clostridium difficile/ 6,719
2 exp Intensive Care Units, Neonatal/ or exp Intensive Care, Neonatal/ 15,068
3 exp Infant, Newborn/ 541,022
4 2 or 3 542,198
5 1 and 4 152
6 limit 5 to (English language and humans) 139

Table 2. EMBASE® Search Strategy

Order of search, EMBASE search terms, and number of results for each search
# Search History Results
1 ‘clostridium difficile’/exp or ‘clostridium difficile infection’/exp 9,594
2 ‘newborn’/exp or ‘newborn intensive care’/exp 351,852
3 1 and 2 68
4 Limit 3 to (English language and humans and EMBASE®) 59

Table 3. Cochrane Library Search Strategy

Order of search, Cochrane Library search terms, and number of results for each search
# Search History Results
1 MeSH descriptor Clostridium difficile explode all trees 186
2 MeSH descriptor Infant, Newborn explode all trees 14,329
3 MeSH descriptor Intensive Care Units, Neonatal explode all trees 559
4 MeSH descriptor Intensive Care, Neonatal explode all trees 307
5 2 or 3 or 4 14,370
6 1 and 5 1

Table 4. CINAHL® Search Strategy

Order of search, CINAHL search terms, and number of results for each search
# Search History Results
1 (MH “Infant, Newborn+”) or (MH “Intensive Care Units, Neonatal”) or (MH “Intensive Care, Neonatal+”) 72,510
2 MH “Clostridium Difficile” 1,525
3 1 and 2 17
4 Limit 3 to (English language; exclude MEDLINE records) 2

2. Study Exclusion Criteria

  • Meeting abstract only
  • No full text available
  • Not in English
  • Not primary research
  • Examines fewer than 10 C. difficile-infected infants
  • Majority of study population not comprised of infants in NICUs
  • Mixed patient population and study does not include subanalysis of NICU patients
  • Only describes methods for surveillance of healthcare-associated infections
  • Study conducted outside the US and only describes epidemiology of C. difficile
  • Only describes molecular biology of C. difficile
  • Only describes molecular epidemiology of C. difficile without any clinical information
  • Does not include comparison group (e.g., case series of C. difficile infection)
  • Does not provide a clear description of the intervention(s) and statistical analysis that compares time points before and after intervention
  • Not relevant to any Question
    • Question A: What clinical, demographic, or other criteria have been shown to prompt diagnostic testing for difficile that results in identifying symptomatic C. difficile-infected NICU patients?
    • Question B: What tests or sequence of tests for C. difficile perform best in detecting CDI among NICU patients?
    • Question C: What is the significance of a positive C. difficile test in NICU patients?
  • Addresses Key Question B but does not report test performance characteristics (sensitivity, specificity, positive predictive value, negative predictive value) or data that could be used to calculate these performance characteristics