A268 TESTING AND TREATMENT OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED INFLAMMATORY BOWEL DISEASE PATIENTS
Notice bibliographique
Résumé
Inflammatory bowel disease (IBD) is associated with an increased risk of contracting clostridium difficile infection (CDI) as well as an increased mortality risk in the setting of CDI. As such, early testing and treatment of CDI in IBD patients hospitalized for a disease flare is of paramount importance. To assess rates of C. difficile testing and treatment patterns among IBD patients admitted to The Ottawa Hospital for a disease flare. To characterize factors associated with appropriate testing of Clostridium Difficile infection (CDI) in this setting. A cross-sectional study was conducted in 200 consecutive patients admitted to our tertiary-care center for an IBD flare between January 1, 2011 and December 31, 2013. Outcomes assessed include the frequency and timing of CDI testing, type of CDI treatment and colectomy. Multivariable logistic regression was conducted to assess factors associated with CDI testing within 48 hours of admission. Of 193 patients without known CDI at presentation, 162 patients (84%) were tested for CDI during admission and 153 patients (79%) were tested within 48 hours of presentation. Patients were more likely to be tested for CDI within 48 hours if they had ulcerative (UC) (vs. Crohn’s disease (CD)) (88.7% vs 75.4%, p =0.048), if they were not on immunosuppressive (IS) therapy (vs. on IS therapy) at presentation (95.2% vs 76.5%, p=0.0075) and if they were admitted under a gastroenterologist (vs. non-gastroenterologist) (90.1% vs 74.1%, p < 0.0001). In multivariable analysis, UC diagnosis (aOR 2.4, 95% CI 1.1–5.1), admission under a gastroenterologist (aOR 3.1, 95% CI 1.4–6.8) and absence of corticosteroid therapy at presentation to hospital (aOR 3.2, 95% CI 1.5–6.8) were associated with higher rates of CDI testing within 48 hours of presentation. Of 20 patients who were positive for CDI, 16 patients (80%) received vancomycin +/- metronidazole as first line therapy. Fifteen patients (83%) with CDI diagnosed within 48 hours of admission received supplemental IS therapy for treatment of IBD. In-hospital colectomy was performed in 15% vs 6% of patients with and without CDI, respectively. A substantial proportion of IBD patients admitted to a tertiary-care center for a disease flare are not tested for CDI in a timely fashion. Patients who have UC, who are not on corticosteroids at presentation and who are admitted under a gastroenterologist are more likely to undergo CDI testing. Treatment of CDI in this setting is inconsistent and does not follow recommendations for first-line use of vancomycin in many patients. Better education of physicians who care for IBD patients is required to reduce these gaps in quality of care. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».