Excluded Studies

Mary Butler; Andrew Olson; Dimitri Drekonja; Aasma Shaukat; Natalie Schwehr; Nathan Shippee; Timothy J Wilt

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Butler M, Olson A, Drekonja D, et al. Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Mar. (Comparative Effectiveness Reviews, No. 172.)

Cover of Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update

Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update [Internet].

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Appendix CExcluded Studies

(reason for exclusion appears in italics after each reference)

Key Question 1

1.: Agaronov M, Karak SG, Maldonado Y, et al. Comparison of GeneXpert PCR to BD GeneOhm for detecting C. difficile toxin gene in GDH positive toxin negative samples. Annals of Clinical & Laboratory Science. 2012;42(4):397–400. indeterminate samples only. [PubMed: 23090736]
2.: Baker I, Leeming JP, Reynolds R, et al. Clinical relevance of a positive molecular test in the diagnosis of Clostridium difficile infection. Journal of Hospital Infection. 2013 Aug;84(4):311–5. ref standard not applied to all samples. [PubMed: 23831282]
3.: Barbut F, Surgers L, Eckert C, et al. Does a rapid diagnosis of Clostridium difficile infection impact on quality of patient management? Clinical Microbiology & Infection. 2014 Feb;20(2):136–44. inadequate reference standard. [PubMed: 23565919]
4.: Beck ET, Buchan BW, Riebe KM, et al. Multicenter evaluation of the Quidel Lyra Direct C. difficile nucleic acid amplification assay. Journal of Clinical Microbiology. 2014 Jun;52(6):1998–2002. test component only. [PMC free article: PMC4042815] [PubMed: 24671790]
5.: Behroozian AA, Chludzinski JP, Lo ES, et al. Detection of mixed populations of Clostridium difficile from symptomatic patients using capillary-based polymerase chain reaction ribotyping. Infection Control & Hospital Epidemiology. 2013 Sep;34(9):961–6. typing only. [PMC free article: PMC4016961] [PubMed: 23917911]
6.: Berry N, Sewell B, Jafri S, et al. Real-time polymerase chain reaction correlates well with clinical diagnosis of Clostridium difficile infection. Journal of Hospital Infection. 2014 Jun;87(2):109–14. inadequate reference standard. [PubMed: 24795170]
7.: Bomers MK, Menke FP, Savage RS, et al. Rapid, Accurate, and On-Site Detection of C. difficile in Stool Samples. American Journal of Gastroenterology. 2015 Apr;110(4):588–94. standard samples. [PubMed: 25823766]
8.: Boyanton BL Jr., Sural P, Loomis CR, et al. Loop-mediated isothermal amplification compared to real-time PCR and enzyme immunoassay for toxigenic Clostridium difficile detection. Journal of Clinical Microbiology. 2012 Mar;50(3):640–5. ref standard not applied to all samples. [PMC free article: PMC3295153] [PubMed: 22189114]
9.: Catanzaro M, Cirone J. Real-time polymerase chain reaction testing for Clostridium difficile reduces isolation time and improves patient management in a small community hospital. American Journal of Infection Control. 2012 Sep;40(7):663–6. ref standard not applied to all samples. [PubMed: 22153847]
10.: Chapin KC, Dickenson RA, Wu F, et al. Comparison of five assays for detection of Clostridium difficile toxin. Journal of Molecular Diagnostics. 2011 Jul;13(4):395–400. ref standard not applied to all samples. [PMC free article: PMC3123782] [PubMed: 21704273]
11.: Church DL, Chow BL, Lloyd T, et al. Evaluation of automated repetitive-sequence-based PCR (DiversiLab) compared to PCR ribotyping for rapid molecular typing of community- and nosocomial-acquired Clostridium difficile. Diagnostic Microbiology & Infectious Disease. 2011 Jun;70(2):183–90. typing only. [PubMed: 21596222]
12.: Cohen J, Limbago B, Dumyati G, et al. Impact of changes in Clostridium difficile testing practices on stool rejection policies and C. difficile positivity rates across multiple laboratories in the United States. Journal of Clinical Microbiology. 2014 Feb;52(2):632–4. ref standard not applied to all samples. [PMC free article: PMC3911329] [PubMed: 24478500]
13.: Deak E, Miller SA, Humphries RM. Comparison of Illumigene, Simplexa, and AmpliVue Clostridium difficile molecular assays for diagnosis of C. difficile infection. Journal of Clinical Microbiology. 2014 Mar;52(3):960–3. ref standard not applied to all samples. [PMC free article: PMC3957777] [PubMed: 24352999]
14.: Denys GA. Portrait Toxigenic Clostridium difficile assay, an isothermal amplification assay detects toxigenic C. difficile in clinical stool specimens. Expert Review of Molecular Diagnostics. 2014 Jan;14(1):17–26. not study design. [PubMed: 24308336]
15.: Deshpande A, Pasupuleti V, Patel P, et al. Repeat stool testing for Clostridium difficile using enzyme immunoassay in patients with inflammatory bowel disease increases diagnostic yield. Current Medical Research & Opinion. 2012 Sep;28(9):1553–60. ref standard not applied to all samples. [PubMed: 22852871]
16.: Dionne LL, Raymond F, Corbeil J, et al. Correlation between Clostridium difficile bacterial load, commercial real-time PCR cycle thresholds, and results of diagnostic tests based on enzyme immunoassay and cell culture cytotoxicity assay. Journal of Clinical Microbiology. 2013 Nov;51(11):3624–30. standard samples. [PMC free article: PMC3889743] [PubMed: 23966497]
17.: Doing KM, Hintz MS. Prospective evaluation of the Meridian Illumigene loop-mediated amplification assay and the Gen Probe ProGastro Cd polymerase chain reaction assay for the direct detection of toxigenic Clostridium difficile from fecal samples. Diagnostic Microbiology & Infectious Disease. 2012 Jan;72(1):8–13. ref standard not applied to all samples. [PubMed: 22015321]
18.: Dubberke ER, Han Z, Bobo L, et al. Impact of clinical symptoms on interpretation of diagnostic assays for Clostridium difficile infections. Journal of Clinical Microbiology. 2011 Aug;49(8):2887–93. patients not randomly or consecutively selected. [PMC free article: PMC3147743] [PubMed: 21697328]
19.: Eckert C, Burghoffer B, Lalande V, et al. Evaluation of the chromogenic agar chromID C. difficile. Journal of Clinical Microbiology. 2013 Mar;51(3):1002–4. culture study only. [PMC free article: PMC3592044] [PubMed: 23269743]
20.: Eckert C, Van Broeck J, Spigaglia P, et al. Comparison of a commercially available repetitive-element PCR system (DiversiLab) with PCR ribotyping for typing of clostridium difficile strains. Journal of Clinical Microbiology. 2011 Sep;49(9):3352–4. typing only. [PMC free article: PMC3165626] [PubMed: 21775548]
21.: Freifeld AG, Simonsen KA, Booth CS, et al. A new rapid method for Clostridium difficile DNA extraction and detection in stool: toward point-of-care diagnostic testing. Journal of Molecular Diagnostics. 2012 May-Jun;14(3):274–9. ref standard not applied to all samples. [PubMed: 22402170]
22.: Goldenberg SD, Dieringer T, French GL. Detection of toxigenic Clostridium difficile in diarrheal stools by rapid real-time polymerase chain reaction. Diagnostic Microbiology & Infectious Disease. 2010 Jul;67(3):304–7. patients not randomly or consecutively selected. [PubMed: 20542211]
23.: Grein JD, Ochner M, Hoang H, et al. Comparison of testing approaches for Clostridium difficile infection at a large community hospital. Clinical Microbiology & Infection. 2014 Jan;20(1):65–9. inadequate reference standard. [PubMed: 23521523]
24.: Guerrero DM, Chou C, Jury LA, et al. Clinical and infection control implications of Clostridium difficile infection with negative enzyme immunoassay for toxin. Clinical Infectious Diseases. 2011 Aug 1;53(3):287–90. ref standard not applied to all samples. [PubMed: 21765078]
25.: Gyorke CE, Wang S, Leslie JL, et al. Evaluation of Clostridium difficile fecal load and limit of detection during a prospective comparison of two molecular tests, the illumigene C. difficile and Xpert C. difficile/Epi tests. Journal of Clinical Microbiology. 2013 Jan;51(1):278–80. inadequate reference standard. [PMC free article: PMC3536201] [PubMed: 23052320]
26.: Han Z, McMullen KM, Russo AJ, et al. A Clostridium difficile infection “intervention”: change in toxin assay results in fewer C difficile infection cases without changes in patient outcomes. American Journal of Infection Control. 2012 May;40(4):349–53. ref standard not applied to all samples. [PMC free article: PMC4156412] [PubMed: 21794950]
27.: Hernandez-Rocha C, Barra-Carrasco J, Alvarez-Lobos M, et al. Prospective comparison of a commercial multiplex real-time polymerase chain reaction and an enzyme immunoassay with toxigenic culture in the diagnosis of Clostridium difficile-associated infections. Diagnostic Microbiology & Infectious Disease. 2013 Apr;75(4):361–5. ref standard not applied to all samples. [PubMed: 23415540]
28.: Huang B, Jin D, Zhang J, et al. Real-time cellular analysis coupled with a specimen enrichment accurately detects and quantifies Clostridium difficile toxins in stool. Journal of Clinical Microbiology. 2014 Apr;52(4):1105–11. non-standard test. [PMC free article: PMC3993479] [PubMed: 24452160]
29.: Ingle M, Deshmukh A, Desai D, et al. Clostridium difficile as a cause of acute diarrhea: a prospective study in a tertiary care center. Indian Journal of Gastroenterology. 2013 May;32(3):179–83. ref standard not applied to all samples. [PubMed: 23526401]
30.: Kaltsas A, Simon M, Unruh LH, et al. Clinical and laboratory characteristics of Clostridium difficile infection in patients with discordant diagnostic test results. Journal of Clinical Microbiology. 2012 Apr;50(4):1303–7. discordant test results. [PMC free article: PMC3318505] [PubMed: 22238444]
31.: Kamboj M, Babady NE, Marsh JW, et al. Estimating risk of C. difficile transmission from PCR positive but cytotoxin negative cases. PLoS ONE. 2014;9(2):e88262. [Electronic Resource] pediatric patients. [PMC free article: PMC3921148] [PubMed: 24523882]
32.: Karre T, Sloan L, Patel R, et al. Comparison of two commercial molecular assays to a laboratory-developed molecular assay for diagnosis of Clostridium difficile infection. Journal of Clinical Microbiology. 2011 Feb;49(2):725–7. ref standard not applied to all samples. [PMC free article: PMC3043497] [PubMed: 21123537]
33.: Khanna S, Pardi DS, Rosenblatt JE, et al. An evaluation of repeat stool testing for Clostridium difficile infection by polymerase chain reaction. Journal of Clinical Gastroenterology. 2012 Nov-Dec;46(10):846–9. ref standard not applied to all samples. [PubMed: 22334221]
34.: Koo HL, Van JN, Zhao M, et al. Real-time polymerase chain reaction detection of asymptomatic Clostridium difficile colonization and rising C. difficile-associated disease rates. Infection Control & Hospital Epidemiology. 2014 Jun;35(6):667–73. not study design. [PubMed: 24799643]
35.: LaSala PR, Svensson AM, Mohammad AA, et al. Comparison of analytical and clinical performance of three methods for detection of Clostridium difficile. Archives of Pathology & Laboratory Medicine. 2012 May;136(5):527–31. ref standard not applied to all samples. [PubMed: 22540301]
36.: Leibowitz J, Soma VL, Rosen L, et al. Similar proportions of stool specimens from hospitalized children with and without diarrhea test positive for Clostridium difficile. Pediatric Infectious Disease Journal. 2015 Mar;34(3):261–6. pediatric patients. [PubMed: 25247582]
37.: Leis JA, Gold WL, Ng J, et al. Indeterminate tcdB using a Clostridium difficile PCR assay: a retrospective cohort study. BMC Infectious Diseases. 2013;13:324. indeterminate samples only. [PMC free article: PMC3718660] [PubMed: 23865713]
38.: Leslie JL, Cohen SH, Solnick JV, et al. Role of fecal Clostridium difficile load in discrepancies between toxin tests and PCR: is quantitation the next step in C. difficile testing? European Journal of Clinical Microbiology & Infectious Diseases. 2012 Dec;31(12):3295–9. [Erratum appears in Eur J Clin Microbiol Infect Dis. 2012 Dec;31(12):3301] not study design. [PMC free article: PMC3753214] [PubMed: 22814877]
39.: Liu C, Jiang DN, Xiang GM, et al. DNA detection of Clostridium difficile infection based on real-time resistance measurement. Genetics & Molecular Research. 2013;12(3):3296–304. standard samples. [PubMed: 24065671]
40.: Longtin Y, Trottier S, Brochu G, et al. Impact of the type of diagnostic assay on Clostridium difficile infection and complication rates in a mandatory reporting program. Clinical Infectious Diseases. 2013 Jan;56(1):67–73. ref standard not applied to all samples. [PubMed: 23011147]
41.: Luk S, To WK, Ng TK, et al. A cost-effective approach for detection of toxigenic Clostridium difficile: toxigenic culture using ChromID Clostridium difficile agar. Journal of Clinical Microbiology. 2014 Feb;52(2):671–3. non-standard test. [PMC free article: PMC3911300] [PubMed: 24478510]
42.: Luna RA, Boyanton BL Jr., Mehta S, et al. Rapid stool-based diagnosis of Clostridium difficile infection by real-time PCR in a children's hospital. Journal of Clinical Microbiology. 2011 Mar;49(3):851–7. pediatric patients. [PMC free article: PMC3067744] [PubMed: 21209161]
43.: McAuliffe GN, Anderson TP, Stevens M, et al. Systematic application of multiplex PCR enhances the detection of bacteria, parasites, and viruses in stool samples. Journal of Infection. 2013 Aug;67(2):122–9. ref standard not applied to all samples. [PubMed: 23603249]
44.: McElgunn CJ, Pereira CR, Parham NJ, et al. A low complexity rapid molecular method for detection of Clostridium difficile in stool. PLoS ONE. 2014;9(1):e83808. [Electronic Resource] non-standard test. [PMC free article: PMC3885522] [PubMed: 24416173]
45.: Moehring RW, Lofgren ET, Anderson DJ. Impact of change to molecular testing for Clostridium difficile infection on healthcare facility-associated incidence rates. Infection Control & Hospital Epidemiology. 2013 Oct;34(10):1055–61. ref standard not applied to all samples. [PMC free article: PMC3967243] [PubMed: 24018922]
46.: Munson E, Bilbo D, Paul M, et al. Modifications of commercial toxigenic Clostridium difficile PCR resulting in improved economy and workflow efficiency. Journal of Clinical Microbiology. 2011 Jun;49(6):2279–82. ref standard not applied to all samples. [PMC free article: PMC3122720] [PubMed: 21450967]
47.: Murad YM, Perez J, Nokhbeh R, et al. Impact of polymerase chain reaction testing on Clostridium difficile infection rates in an acute health care facility. American Journal of Infection Control. 2015 Apr 1;43(4):383–6. inadequate reference standard. [PubMed: 25687359]
48.: Naaber P, Stsepetova J, Smidt I, et al. Quantification of Clostridium difficile in antibiotic-associated-diarrhea patients. Journal of Clinical Microbiology. 2011 Oct;49(10):3656–8. non-standard test. [PMC free article: PMC3187345] [PubMed: 21865427]
49.: Nolte FS, Ribeiro-Nesbitt DG. Clinical comparison of Simplexa universal direct and BD GeneOhm tests for detection of toxigenic Clostridium difficile in stool samples. Journal of Clinical Microbiology. 2014 Jan;52(1):281–2. inadequate reference standard. [PMC free article: PMC3911450] [PubMed: 24197886]
50.: Onori M, Coltella L, Mancinelli L, et al. Evaluation of a multiplex PCR assay for simultaneous detection of bacterial and viral enteropathogens in stool samples of paediatric patients. Diagnostic Microbiology & Infectious Disease. 2014 Jun;79(2):149–54. pediatric patients. [PubMed: 24656922]
51.: Ota KV, McGowan KL. Clostridium difficile testing algorithms using glutamate dehydrogenase antigen and C. difficile toxin enzyme immunoassays with C. difficile nucleic acid amplification testing increase diagnostic yield in a tertiary pediatric population. Journal of Clinical Microbiology. 2012 Apr;50(4):1185–8. pediatric patients. [PMC free article: PMC3318566] [PubMed: 22259201]
52.: Pancholi P, Kelly C, Raczkowski M, et al. Detection of toxigenic Clostridium difficile: comparison of the cell culture neutralization, Xpert C. difficile, Xpert C. difficile/Epi, and Illumigene C. difficile assays. Journal of Clinical Microbiology. 2012 Apr;50(4):1331–5. ref standard not applied to all samples. [PMC free article: PMC3318532] [PubMed: 22278839]
53.: Perry MD, Corden SA, Howe RA. Evaluation of the Luminex xTAG Gastrointestinal Pathogen Panel and the Savyon Diagnostics Gastrointestinal Infection Panel for the detection of enteric pathogens in clinical samples. Journal of Medical Microbiology. 2014 Nov;63(Pt 11):1419–26. inadequate reference standard. [PubMed: 25102908]
54.: Pollock NR, Song L, Zhao M, et al. Differential Immunodetection of Toxin B from Highly Virulent Clostridium difficile BI/NAP-1/027. Journal of Clinical Microbiology. 2015 May;53(5):1705–8. non-standard test. [PMC free article: PMC4400753] [PubMed: 25716449]
55.: Samra Z, Madar-Shapiro L, Aziz M, et al. Evaluation of a new immunochromatography test for rapid and simultaneous detection of Clostridium difficile antigen and toxins. Israel Medical Association Journal: Imaj. 2013 Jul;15(7):373–6. inadequate reference standard. [PubMed: 23943984]
56.: Schneeberg A, Ehricht R, Slickers P, et al. DNA microarray-based PCR ribotyping of Clostridium difficile. Journal of Clinical Microbiology. 2015 Feb;53(2):433–42. typing only. [PMC free article: PMC4298559] [PubMed: 25411174]
57.: Schroeder LF, Robilotti E, Peterson LR, et al. Economic evaluation of laboratory testing strategies for hospital-associated Clostridium difficile infection. Journal of Clinical Microbiology. 2014 Feb;52(2):489–96. not study design. [PMC free article: PMC3911327] [PubMed: 24478478]
58.: Selvaraju SB, Gripka M, Estes K, et al. Detection of toxigenic Clostridium difficile in pediatric stool samples: an evaluation of Quik Check Complete Antigen assay, BD GeneOhm Cdiff PCR, and ProGastro Cd PCR assays. Diagnostic Microbiology & Infectious Disease. 2011 Nov;71(3):224–9. pediatric patients. [PubMed: 21899975]
59.: Shin BM, Lee EJ. Comparison of ChromID agar and Clostridium difficile selective agar for effective isolation of C. difficile from stool specimens. Annals of Laboratory Medicine. 2014 Jan;34(1):15–9. culture study only. [PMC free article: PMC3885767] [PubMed: 24422190]
60.: Stellrecht KA, Espino AA, Maceira VP, et al. Premarket evaluations of the IMDx C. difficile for Abbott m2000 Assay and the BD Max Cdiff Assay. Journal of Clinical Microbiology. 2014 May;52(5):1423–8. inadequate reference standard. [PMC free article: PMC3993703] [PubMed: 24554744]
61.: Stockmann C, Rogatcheva M, Harrel B, et al. How well does physician selection of microbiologic tests identify Clostridium difficile and other pathogens in paediatric diarrhoea? Insights using multiplex PCR-based detection. Clinical Microbiology & Infection. 2015 Feb;21(2):179.e9–15. pediatric patients. [PMC free article: PMC4330102] [PubMed: 25599941]
62.: Sunkesula VC, Kundrapu S, Muganda C, et al. Does empirical Clostridium difficile infection (CDI) therapy result in false-negative CDI diagnostic test results? Clinical Infectious Diseases. 2013 Aug;57(4):494–500. only patients with CDI. [PubMed: 23645849]
63.: Sydnor ER, Lenhart A, Trollinger B, et al. Antimicrobial prescribing practices in response to different Clostridium difficile diagnostic methodologies. Infection Control & Hospital Epidemiology. 2011 Nov;32(11):1133–6. inadequate reference standard. [PubMed: 22011545]
64.: Tenover FC, Akerlund T, Gerding DN, et al. Comparison of strain typing results for Clostridium difficile isolates from North America. Journal of Clinical Microbiology. 2011 May;49(5):1831–7. typing only. [PMC free article: PMC3122689] [PubMed: 21389155]
65.: Toltzis P, Nerandzic MM, Saade E, et al. High proportion of false-positive Clostridium difficile enzyme immunoassays for toxin A and B in pediatric patients. Infection Control & Hospital Epidemiology. 2012 Feb;33(2):175–9. pediatric patients. [PubMed: 22227987]
66.: Tsaloglou MN, Watson RJ, Rushworth CM, et al. Real-time microfluidic recombinase polymerase amplification for the toxin B gene of Clostridium difficile on a SlipChip platform. Analyst. 2015 Jan 7;140(1):258–64. non-standard test. [PubMed: 25371968]
67.: Tyrrell KL, Citron DM, Leoncio ES, et al. Evaluation of cycloserine-cefoxitin fructose agar (CCFA), CCFA with horse blood and taurocholate, and cycloserine-cefoxitin mannitol broth with taurocholate and lysozyme for recovery of Clostridium difficile isolates from fecal samples. Journal of Clinical Microbiology. 2013 Sep;51(9):3094–6. culture study only. [PMC free article: PMC3754669] [PubMed: 23804392]
68.: Vasoo S, Stevens J, Portillo L, et al. Cost-effectiveness of a modified two-step algorithm using a combined glutamate dehydrogenase/toxin enzyme immunoassay and real-time PCR for the diagnosis of Clostridium difficile infection. Journal of Microbiology, Immunology & Infection. 2014 Feb;47(1):75–8. inadequate reference standard. [PubMed: 22921803]
69.: Verhoeven PO, Carricajo A, Pillet S, et al. Evaluation of the new CE-IVD marked BD MAX Cdiff Assay for the detection of toxigenic Clostridium difficile harboring the tcdB gene from clinical stool samples. Journal of Microbiological Methods. 2013 Jul;94(1):58–60. ref standard not applied to all samples. [PubMed: 23643507]
70.: Wang Y, Atreja A, Wu X, et al. Similar outcomes of IBD inpatients with Clostridium difficile infection detected by ELISA or PCR assay. Digestive Diseases & Sciences. 2013 Aug;58(8):2308–13. ref standard not applied to all samples. [PubMed: 23525735]
71.: Wei HL, Kao CW, Wei SH, et al. Comparison of PCR ribotyping and multilocus variable-number tandem-repeat analysis (MLVA) for improved detection of Clostridium difficile. BMC Microbiology. 2011;11:217. typing only. [PMC free article: PMC3191483] [PubMed: 21961456]
72.: Whang DH, Joo SY. Evaluation of the diagnostic performance of the xpert Clostridium difficile assay and its comparison with the toxin A/B enzyme-linked fluorescent assay and in-house real-time PCR assay used for the detection of toxigenic C. difficile. Journal of Clinical Laboratory Analysis. 2014 Mar;28(2):124–9. inadequate reference standard. [PMC free article: PMC6807546] [PubMed: 24395702]
73.: Whitehead SJ, Shipman KE, Cooper M, et al. Is there any value in measuring faecal calprotectin in Clostridium difficile positive faecal samples? Journal of Medical Microbiology. 2014 Apr;63(Pt 4):590–3. non-standard test. [PubMed: 24464697]
74.: Wilson R, Beerbaum P, Giglio S. Community and hospital acquired Clostridium difficile in South Australia - ribotyping of isolates and a comparison of laboratory detection methods. Letters in Applied Microbiology. 2015 Jan;60(1):33–6. inadequate reference standard. [PubMed: 25274056]
75.: Xiao M, Kong F, Jin P, et al. Comparison of two capillary gel electrophoresis systems for Clostridium difficile ribotyping, using a panel of ribotype 027 isolates and whole-genome sequences as a reference standard. Journal of Clinical Microbiology. 2012 Aug;50(8):2755–60. standard samples. [PMC free article: PMC3421540] [PubMed: 22692737]

Key Question 2

1.: Aldeyab MA, Kearney MP, Scott MG, et al. An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. Journal of Antimicrobial Chemotherapy. 2012 December;67(12) duplicate with systematic review. [PubMed: 22899806]
2.: Al-Obaydi W, Smith CD, Foguet P. Changing prophylactic antibiotic protocol for reducing Clostridium difficile-associated diarrhoeal infections. Journal of orthopaedic surgery (Hong Kong). 2010 Dec;18(3):320–3. not study design. [PubMed: 21187543]
3.: Amer MR, Akhras NS, Mahmood WA, et al. Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia. Annals of Saudi Medicine. 2013 November-December;33(6):547–54. not study design. [PMC free article: PMC6074906] [PubMed: 24413857]
4.: Anderson DJ, Gergen MF, Smathers E, et al. Decontamination of targeted pathogens from patient rooms using an automated ultraviolet-C-emitting device. Infection Control & Hospital Epidemiology. 2013 May;34(5):466–71. not on topic. [PMC free article: PMC3703853] [PubMed: 23571362]
5.: Cook PP, Gooch M. Long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital. International Journal of Antimicrobial Agents. 2015 Mar;45(3):262–7. not study design. [PubMed: 25554468]
6.: Craxford S, Bayley E, Needoff M. Antibiotic-associated complications following lower limb arthroplasty: a comparison of two prophylactic regimes. European journal of orthopaedic surgery & traumatologie. 2014 May;24(4):539–43. not on topic. [PubMed: 24178085]
7.: Cruz-Rodriguez NC, Hernandez-Garcia R, Salinas-Caballero AG, et al. The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward. American Journal of Infection Control. 2014 Jun;42(6):e71–3. not study design. [PubMed: 24837129]
8.: Curtin BF, Zarbalian Y, Flasar MH, et al. Clostridium difficile-associated disease: adherence with current guidelines at a tertiary medical center. World Journal of Gastroenterology. 2013 Dec 14;19(46):8647–51. not on topic. [PMC free article: PMC3870510] [PubMed: 24379582]
9.: Davies A, Pottage T, Bennett A, et al. Gaseous and air decontamination technologies for Clostridium difficile in the healthcare environment. Journal of Hospital Infection. 2011 Mar;77(3):199–203. not on topic. [PubMed: 21130521]
10.: Dellit TH, Chan JD, Fulton C, et al. Reduction in Clostridium difficile infections among neurosurgical patients associated with discontinuation of antimicrobial prophylaxis for the duration of external ventricular drain placement. Infection Control & Hospital Epidemiology. 2014 May;35(5):589–90. not on topic. [PubMed: 24709732]
11.: Deshpande A, Sitzlar B, Fertelli D, et al. Utility of an adenosine triphosphate bioluminescence assay to evaluate disinfection of Clostridium difficile isolation rooms. Infection Control & Hospital Epidemiology. 2013 Aug;34(8):865–7. not on topic. [PubMed: 23838235]
12.: Doan L, Forrest H, Fakis A, et al. Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027. Journal of Hospital Infection. 2012 Oct;82(2):114–21. not on topic. [PubMed: 22902081]
13.: Edmonds SL, Zapka C, Kasper D, et al. Effectiveness of hand hygiene for removal of Clostridium difficile spores from hands. Infection Control & Hospital Epidemiology. 2013 Mar;34(3):302–5. not on topic. [PubMed: 23388366]
14.: Elligsen M, Walker SAN, Pinto R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: A controlled interrupted time series analysis. Infection Control and Hospital Epidemiology. 2012 April;33(4):354–61. duplicate with systematic review. [PubMed: 22418630]
15.: Falagas ME, Thomaidis PC, Kotsantis IK, et al. Airborne hydrogen peroxide for disinfection of the hospital environment and infection control: a systematic review. Journal of Hospital Infection. 2011 Jul;78(3):171–7. not on topic. [PubMed: 21392848]
16.: Feazel LM, Malhotra A, Perencevich EN, et al. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy. 2014 Jul;69(7):1748–54. not study design. [PubMed: 24633207]
17.: Fu TY, Gent P, Kumar V. Efficacy, efficiency and safety aspects of hydrogen peroxide vapour and aerosolized hydrogen peroxide room disinfection systems. Journal of Hospital Infection. 2012 Mar;80(3):199–205. not on topic. [PubMed: 22306442]
18.: Guerrero DM, Carling PC, Jury LA, et al. Beyond the Hawthorne effect: reduction of Clostridium difficile environmental contamination through active intervention to improve cleaning practices. Infection Control & Hospital Epidemiology. 2013 May;34(5):524–6. not on topic. [PubMed: 23571372]
19.: Guerrero DM, Nerandzic MM, Jury LA, et al. Acquisition of spores on gloved hands after contact with the skin of patients with Clostridium difficile infection and with environmental surfaces in their rooms. American Journal of Infection Control. 2012 Aug;40(6):556–8. not on topic. [PubMed: 21982209]
20.: Haas JP, Menz J, Dusza S, et al. Implementation and impact of ultraviolet environmental disinfection in an acute care setting. American Journal of Infection Control. 2014 Jun;42(6):586–90. not outcomes. [PubMed: 24837107]
21.: Havill NL, Moore BA, Boyce JM. Comparison of the microbiological efficacy of hydrogen peroxide vapor and ultraviolet light processes for room decontamination. Infection Control & Hospital Epidemiology. 2012 May;33(5):507–12. not on topic. [PubMed: 22476278]
22.: Jabbar U, Leischner J, Kasper D, et al. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infection Control & Hospital Epidemiology. 2010 Jun;31(6):565–70. not on topic. [PubMed: 20429659]
23.: Jayaraman SP, Askari R, Bascom M, et al. Differential impact of infection control strategies on rates of resistant hospital-acquired pathogens in critically ill surgical patients. Surgical Infections. 2014 Dec 01;15(6):726–32. not study design. [PubMed: 25496277]
24.: Jayaraman SP, Klompas M, Bascom M, et al. Hand-hygiene compliance does not predict rates of resistant infections in critically ill surgical patients. Surgical Infections. 2014 Oct 01;15(5):533–9. not study design. [PubMed: 25215463]
25.: Jury LA, Guerrero DM, Burant CJ, et al. Effectiveness of routine patient bathing to decrease the burden of spores on the skin of patients with Clostridium difficile infection. Infection Control & Hospital Epidemiology. 2011 Feb;32(2):181–4. not on topic. [PubMed: 21460475]
26.: Kassakian SZ, Mermel LA, Jefferson JA, et al. Impact of chlorhexidine bathing on hospital-acquired infections among general medical patients. Infection Control & Hospital Epidemiology. 2011 Mar;32(3):238–43. not on topic. [PubMed: 21460508]
27.: Kim JW, Lee KL, Jeong JB, et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World Journal of Gastroenterology. 2010 Jul 28;16(28):3573–7. not on topic. [PMC free article: PMC2909558] [PubMed: 20653067]
28.: Kirkland KB, Homa KA, Lasky RA, et al. Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: Results of an interrupted time series. BMJ Quality and Safety. 2012 December;21(12):1019–26. not outcomes. [PubMed: 22822243]
29.: Kundrapu S, Sunkesula V, Jury LA, et al. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers' hands. Infection Control & Hospital Epidemiology. 2012 Oct;33(10):1039–42. not on topic. [PubMed: 22961024]
30.: Lee TC, Frenette C, Jayaraman D, et al. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Annals of Internal Medicine. 2014 Nov 18;161(10 Suppl):S53–8. not study design. [PubMed: 25402404]
31.: Leung V, Gill S, Sauve J, et al. Growing a “positive culture” of antimicrobial stewardship in a community hospital. Canadian Journal of Hospital Pharmacy. 2011 September-October;64(5):314–20. not study design. [PMC free article: PMC3203822] [PubMed: 22479082]
32.: Lew KY, Ng TM, Tan M, et al. Safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an ESBL-endemic setting. Journal of Antimicrobial Chemotherapy. 2015 Apr;70(4):1219–25. not study design. [PubMed: 25473028]
33.: Liew YX, Lee W, Tay D, et al. Prospective audit and feedback in antimicrobial stewardship: is there value in early reviewing within 48 h of antibiotic prescription? International Journal of Antimicrobial Agents. 2015 Feb;45(2):168–73. not study design. [PubMed: 25511192]
34.: Marufu O, Desai N, Aldred D, et al. Analysis of interventions to reduce the incidence of Clostridium difficile infection at a London teaching hospital trust, 2003-2011. Journal of Hospital Infection. 2015 Jan 01;89(1):38–45. not study design. [PubMed: 25480022]
35.: Moore G, Ali S, Cloutman-Green EA, et al. Use of UV-C radiation to disinfect non-critical patient care items: a laboratory assessment of the Nanoclave Cabinet. BMC Infectious Diseases. 2012;12:174. not on topic. [PMC free article: PMC3449183] [PubMed: 22856652]
36.: Morris AM, Brener S, Dresser L, et al. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infection Control & Hospital Epidemiology. 2012 May;33(5):500–6. not on topic. [PubMed: 22476277]
37.: Nerandzic MM, Cadnum JL, Eckart KE, et al. Evaluation of a hand-held far-ultraviolet radiation device for decontamination of Clostridium difficile and other healthcare-associated pathogens. BMC Infectious Diseases. 2012;12:120. not on topic. [PMC free article: PMC3419611] [PubMed: 22591268]
38.: Nerandzic MM, Rackaityte E, Jury LA, et al. Novel strategies for enhanced removal of persistent Bacillus anthracis surrogates and Clostridium difficile spores from skin. PLoS ONE. 2013;8(7):e68706. [Electronic Resource] not on topic. [PMC free article: PMC3699662] [PubMed: 23844234]
39.: Ostrowsky B, Ruiz R, Brown S, et al. Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions. Infection Control and Hospital Epidemiology. 2014 Oct 01;35:S86–S95. not study design. [PubMed: 25222903]
40.: Oxman DA, Issa NC, Marty FM, et al. Postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial. JAMA Surgery. 2013 May;148(5):440–6. not on topic. [PubMed: 23325435]
41.: Pereira JB, Farragher TM, Tully MP, et al. Association between Clostridium difficile infection and antimicrobial usage in a large group of English hospitals. British Journal of Clinical Pharmacology. 2014 May;77(5):896–903. not study design. [PMC free article: PMC4004410] [PubMed: 24868578]
42.: Pogorzelska M, Stone PW, Larson EL. Certification in infection control matters: Impact of infection control department characteristics and policies on rates of multidrug-resistant infections. American Journal of Infection Control. 2012 Mar;40(2):96–101. not on topic. [PMC free article: PMC3329760] [PubMed: 22381222]
43.: Rutala WA, Gergen MF, Weber DJ. Room decontamination with UV radiation. Infection Control & Hospital Epidemiology. 2010 Oct;31(10):1025–9. not on topic. [PubMed: 20804377]
44.: Rutala WA, Gergen MF, Weber DJ. Efficacy of different cleaning and disinfection methods against Clostridium difficile spores: importance of physical removal versus sporicidal inactivation. Infection Control & Hospital Epidemiology. 2012 Dec;33(12):1255–8. not on topic. [PubMed: 23143366]
45.: Sadahiro S, Suzuki T, Tanaka A, et al. Comparison between oral antibiotics and probiotics as bowel preparation for elective colon cancer surgery to prevent infection: prospective randomized trial. Surgery. 2014 Mar;155(3):493–503. not on topic. [PubMed: 24524389]
46.: Salama MF, Jamal WY, Mousa HA, et al. The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of Infection and Public Health. 2013 February;6(1):27–34. not outcomes. [PubMed: 23290090]
47.: Sexton JD, Tanner BD, Maxwell SL, et al. Reduction in the microbial load on high-touch surfaces in hospital rooms by treatment with a portable saturated steam vapor disinfection system. American Journal of Infection Control. 2011 Oct;39(8):655–62. not on topic. [PubMed: 21641089]
48.: Siani H, Cooper C, Maillard JY. Efficacy of “sporicidal” wipes against Clostridium difficile. American Journal of Infection Control. 2011 Apr;39(3):212–8. not on topic. [PubMed: 21458683]
49.: Sitzlar B, Deshpande A, Fertelli D, et al. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infection Control & Hospital Epidemiology. 2013 May;34(5):459–65. not on topic. [PubMed: 23571361]
50.: Smith DL, Gillanders S, Holah JT, et al. Assessing the efficacy of different microfibre cloths at removing surface micro-organisms associated with healthcare-associated infections. Journal of Hospital Infection. 2011 Jul;78(3):182–6. not on topic. [PubMed: 21501897]
51.: Talpaert MJ, Rao GG, Cooper BS, et al. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. Journal of Antimicrobial Chemotherapy. 2011 September;66(9):2168–74. duplicate with systematic review. [PubMed: 21676904]
52.: Ungurs M, Wand M, Vassey M, et al. The effectiveness of sodium dichloroisocyanurate treatments against Clostridium difficile spores contaminating stainless steel. American Journal of Infection Control. 2011 Apr;39(3):199–205. not on topic. [PubMed: 21288600]
53.: Valerio M, Pedromingo M, Munoz P, et al. Potential protective role of linezolid against Clostridium difficile infection. International Journal of Antimicrobial Agents. 2012 May;39(5):414–9. [Erratum appears in Int J Antimicrob Agents. 2012 Jul;40(1):94] not on topic. [PubMed: 22445203]
54.: Villano SA, Seiberling M, Tatarowicz W, et al. Evaluation of an oral suspension of VP20621, spores of nontoxigenic Clostridium difficile strain M3, in healthy subjects. Antimicrobial Agents & Chemotherapy. 2012 Oct;56(10):5224–9. not on topic. [PMC free article: PMC3457387] [PubMed: 22850511]
55.: Wenisch JM, Equiluz-Bruck S, Fudel M, et al. Decreasing Clostridium difficile infections by an antimicrobial stewardship program that reduces moxifloxacin use. Antimicrobial Agents and Chemotherapy. 2014 September;58(9):5079–83. not study design. [PMC free article: PMC4135825] [PubMed: 24936597]
56.: White RW, West R, Howard P, et al. Antimicrobial regime for cardiac surgery: the safety and effectiveness of short-course flucloxacillin (or teicoplanin) and gentamicin-based prophylaxis. Journal of Cardiac Surgery. 2013 Sep;28(5):512–6. not on topic. [PubMed: 23837413]
57.: Wilson AP, Smyth D, Moore G, et al. The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals. Critical Care Medicine. 2011 Apr;39(4):651–8. not on topic. [PubMed: 21242793]
58.: Wong S, Jamous A, O'Driscoll J, et al. A Lactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries: a randomised controlled trial. British Journal of Nutrition. 2014 Feb;111(4):672–8. not on topic. [PubMed: 24044687]
59.: Yu K, Rho J, Morcos M, et al. Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams. American Journal of Health-System Pharmacy. 2014 Jun 15;71(12):1019–28. not study design. [PubMed: 24865759]

Key Question 3

1.: Chen LF, Anderson DJ. Efficacy and safety of fidaxomicin compared with oral vancomycin for the treatment of adults with Clostridium difficile-associated diarrhea: data from the OPT-80-003 and OPT-80-004 studies. Future Microbiology. 2012 Jun;7(6):677–83. not study design. [PubMed: 22702523]
2.: Clutter DS, Dubrovskaya Y, Merl MY, et al. Fidaxomicin versus conventional antimicrobial therapy in 59 recipients of solid organ and hematopoietic stem cell transplantation with Clostridium difficile-associated diarrhea. Antimicrobial Agents & Chemotherapy. 2013 Sep;57(9):4501–5. not study design. [PMC free article: PMC3754298] [PubMed: 23836168]
3.: Cornely OA, Miller MA, Fantin B, et al. Resolution of Clostridium difficile-associated diarrhea in patients with cancer treated with fidaxomicin or vancomycin. Journal of Clinical Oncology. 2013 Jul 1;31(19):2493–9. not study design. [PubMed: 23715579]
4.: Cornely OA, Miller MA, Louie TJ, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clinical Infectious Diseases. 2012 Aug;55 Suppl 2:S154–61. not study design. [PMC free article: PMC3388030] [PubMed: 22752865]
5.: El Feghaly RE, Stauber JL, Deych E, et al. Markers of intestinal inflammation, not bacterial burden, correlate with clinical outcomes in Clostridium difficile infection. Clinical Infectious Diseases. 2013 Jun;56(12):1713–21. not outcomes. [PMC free article: PMC3707425] [PubMed: 23487367]
6.: Eyre DW, Babakhani F, Griffiths D, et al. Whole-genome sequencing demonstrates that fidaxomicin is superior to vancomycin for preventing reinfection and relapse of infection with Clostridium difficile. Journal of Infectious Diseases. 2014 May 1;209(9):1446–51. not on topic. [PMC free article: PMC3982846] [PubMed: 24218500]
7.: Huang JS, Jiang ZD, Garey KW, et al. Use of rifamycin drugs and development of infection by rifamycin-resistant strains of Clostridium difficile. Antimicrobial Agents & Chemotherapy. 2013 Jun;57(6):2690–3. not outcomes. [PMC free article: PMC3716149] [PubMed: 23545528]
8.: Jardin CG, Palmer HR, Shah DN, et al. Assessment of treatment patterns and patient outcomes before vs after implementation of a severity-based Clostridium difficile infection treatment policy. Journal of Hospital Infection. 2013 Sep;85(1):28–32. not outcomes. [PubMed: 23834988]
9.: Jury LA, Tomas M, Kundrapu S, et al. A Clostridium difficile infection (CDI) stewardship initiative improves adherence to practice guidelines for management of CDI. Infection Control & Hospital Epidemiology. 2013 Nov;34(11):1222–4. not outcomes. [PubMed: 24113611]
10.: Louie TJ, Miller MA, Crook DW, et al. Effect of age on treatment outcomes in Clostridium difficile infection. Journal of the American Geriatrics Society. 2013 Feb;61(2):222–30. not study design. [PubMed: 23379974]
11.: Morrow T. Fewer recurrent infections of C. difficile seen with fidaxomicin. This new class of antibiotic--the macrocycles--has a greater sustained response against re-infection than vancomycin. Managed Care. 2011 Jul;20(7):49–50. not study design. [PubMed: 21848202]
12.: Mullane KM, Cornely OA, Crook DW, et al. Renal impairment and clinical outcomes of Clostridium difficile infection in two randomized trials. American Journal of Nephrology. 2013;38(1):1–11. [Erratum appears in Am J Nephrol. 2013;38(3):266] not study design. [PubMed: 23796582]
13.: Mullane KM, Miller MA, Weiss K, et al. Efficacy of fidaxomicin versus vancomycin as therapy for Clostridium difficile infection in individuals taking concomitant antibiotics for other concurrent infections. Clinical Infectious Diseases. 2011 Sep;53(5):440–7. [Erratum appears in Clin Infect Dis. 2011 Dec;53(12):1312 Note: Dosage error in article text] not study design. [PMC free article: PMC3156139] [PubMed: 21844027]
14.: Petrella LA, Sambol SP, Cheknis A, et al. Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clinical Infectious Diseases. 2012 Aug;55(3):351–7. not study design. [PMC free article: PMC3491778] [PubMed: 22523271]
15.: Stewart DB, Berg A, Hegarty J. Predicting recurrence of C. difficile colitis using bacterial virulence factors: binary toxin is the key. Journal of Gastrointestinal Surgery. 2013 Jan;17(1):118–24. discussion p.24-5. not outcomes. [PubMed: 23086451]
16.: Venugopal AA, Szpunar S, Sanchez K, et al. Assessment of 30-day all-cause mortality in metronidazole-treated patients with Clostridium difficile infection. Scandinavian Journal of Infectious Diseases. 2013 Oct;45(10):786–90. not study design. [PubMed: 23746336]

Key Question 4

1.: Eyre DW, Walker AS, Wyllie D, et al. Predictors of first recurrence of Clostridium difficile infection: implications for initial management. Clinical Infectious Diseases. 2012 Aug;55 Suppl 2:S77–87. not study design. [PMC free article: PMC3388024] [PubMed: 22752869]
2.: Im GY, Modayil RJ, Lin CT, et al. The appendix may protect against Clostridium difficile recurrence. Clinical Gastroenterology & Hepatology. 2011 Dec;9(12):1072–7. not study design. [PubMed: 21699818]
3.: Mullane K, Lee C, Bressler A, et al. Multicenter, randomized clinical trial to compare the safety and efficacy of LFF571 and vancomycin for Clostridium difficile infections. Antimicrobial Agents & Chemotherapy. 2015 Mar;59(3):1435–40. not included intervention. [PMC free article: PMC4325808] [PubMed: 25534727]
4.: Rampelli S, Candela M, Severgnini M, et al. A probiotics-containing biscuit modulates the intestinal microbiota in the elderly. Journal of Nutrition, Health & Aging. 2013 Feb;17(2):166–72. not outcomes. [PubMed: 23364497]
5.: Stollman N, Smith M, Giovanelli A, et al. Frozen Encapsulated Stool in Recurrent Clostridium difficile: Exploring the Role of Pills in the Treatment Hierarchy of Fecal Microbiota Transplant Nonresponders. American Journal of Gastroenterology. 2015 Apr;110(4):600–1. case series <10. [PubMed: 25853204]
6.: Ting LS, Praestgaard J, Grunenberg N, et al. A first-in-human, randomized, double-blind, placebo-controlled, single- and multiple-ascending oral dose study to assess the safety and tolerability of LFF571 in healthy volunteers. Antimicrobial Agents & Chemotherapy. 2012 Nov;56(11):5946–51. not outcomes. [PMC free article: PMC3486596] [PubMed: 22964250]
7.: Ting LSL, Praestgaard J, Grunenberg N, et al. A first-in-human, randomized, double-blind, placebo-controlled, single- and multiple-ascending oral dose study to assess the safety and tolerability of LFF571 in healthy volunteers. Antimicrobial Agents and Chemotherapy. 2012 November;56(11):5946–51. not included intervention. [PMC free article: PMC3486596] [PubMed: 22964250]
8.: Tvede M, Tinggaard M, Helms M. Rectal bacteriotherapy for recurrent Clostridium difficile-associated diarrhoea: results from a case series of 55 patients in Denmark 2000-2012. Clinical Microbiology & Infection. 2015 Jan;21(1):48–53. not included intervention. [PubMed: 25636927]
9.: Vickers R, Robinson N, Best E, et al. A randomised phase 1 study to investigate safety, pharmacokinetics and impact on gut microbiota following single and multiple oral doses in healthy male subjects of SMT19969, a novel agent for Clostridium difficile infections. BMC Infectious Diseases. 2015;15(1):91. not included intervention. [PMC free article: PMC4349307] [PubMed: 25880933]

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Butler M, Olson A, Drekonja D, et al. Early Diagnosis, Prevention, and Treatment of Clostridium difficile: Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Mar. (Comparative Effectiveness Reviews, No. 172.) Appendix C, Excluded Studies.
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