P-225. Effect of isolating <i>Clostridioides difficile</i> asymptomatic carriers on the incidence of healthcare-associated <i>C. difficile</i> infections: a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Background Asymptomatic carriers are a potential source of healthcare-associated Clostridioides difficile infection (HA-CDI). Our objective was to investigate the impact of interventions to detect and isolate asymptomatic carriers during their hospital stay on the incidence of HA-CDI.Figure 1Forest plot of the association between screening and isolating C. difficile carriers on admission and HA-CDI (by random-effects meta-analysis) Methods We performed a systematic review and searched the research literature up to March 2023 for interventional studies where asymptomatic adult patients were screened for C. difficile colonization and were isolated if positive. Only studies that allocated interventions to clusters of individuals and measured outcomes at the population level were eligible. HA-CDI incidence rate ratios were pooled through random effects meta-analysis. Risk of bias was assessed using the Cochrane’s tool for non-randomized studies of interventions.Figure 2Forest plot of the association between screening and isolating C. difficile carriers on admission to hospital or to selected units and HA-CDI (by random-effects meta-analysis) Results 5,681 unique references were screened of which six were eligible. All studies were before-after quasi-experimental interventional studies (2/6 included a control group and 4/6 compared incidence rates during the intervention to before) from high-income countries published between 2016 and 2020 that assessed the effects of hospital-wide or unit-wide screening. Two studies only screened patients at high risk of CDI (e.g. hematologic patients receiving chemotherapy). Four studies were considered to have a serious risk of bias. Among the six included studies, 75,870 patients were screened and 4,104 patients were identified as carriers (the proportion of carriers ranged from 3.1 to 15%). Using a random-effects inverse-variance meta-analysis, screening and isolation of carriers was associated with a significant reduction in the incidence of HA-CDI (N=6, pooled rate ratio 0.28, 95% CI 0.20-0.39). Subgroup analyses yielded similar point estimates for reduction in HA-CDI rates both when screening was done on hospital admission (N=3, RR 0.47, 95% CI 0.24 to 0.94) and on admission to specific hospital units (N=3, RR 0.24, 95% CI 0.16 to 0.34). Conclusion Based on this systematic review and meta-analysis, screening and isolating C. difficile carriers is associated with a decreased incidence of HA-CDI in adult patients. Due to methodological limitations, robust randomized controlled trials are needed to confirm this finding. Disclosures Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,017 | 0,006 |
| Bibliométrie | 0,001 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».