Retrospective study to determine the correlation between the organism load of toxigenic Clostridium difficile and the C. difficile-associated disease
Bibliographic record
Abstract
Background: Clostridium difficile-associated disease (CDAD) is a leading cause of nosocomial diarrhea in adults. Therefore, rapid and accurate reporting of C. difficile is essential. Rapid PCR-based in-house and commercial methods that are highly sensitive and specific are now available. However, PCR-based methods will only detect the presence of toxigenic C. difficile and could be carried by patients without CDAD symptoms. In these cases, the PCR may be presumed as a false-positive test for the disease. The objective of this study is to examine the correlation between the CDAD clinical outcome and the amount of toxigenic C. difficile load and to predict whether there is a relationship between the number of organisms present in patients with CDAD to assist clinicians in their interpretation of results and in making clinical decisions. Methods: The clinical information from 200 randomly selected patients tested positive for the toxigenic C. difficile by a Real-Time Multiplex PCR that detects tcdC and cdtA genes were evaluated. The organism loads were calculated as genomic equivalents by a semi-quantitative real-time C. difficile PCR assay using known concentrations of genomic DNA. The organism load was grouped into high, moderate, and low based on the cycle threshold (CT) values. Patient chart reviews were used to collect multiple variables including age, sex, previous CDAD, previous antibiotic use, underlying medical conditions, and laboratory parameters. Results: The patients aged from 1 year to 95 years with a mean of 60 years and a median of 71 years. Fifty-five percent of the patients were female and 45% were male. Among toxigenic C. difficile strains 39% were NAP1. Most ealderly patients had comorbidities. The majority (81%) had moderate organism loads. Only 15% and 4% had high and low organism loads, respectively. Previous CDAD and the presence of NAP1 gene was noted more in patients with high organism loads. The mortality in high organism load group was 20% compared to none in the low organism load group. All deaths were associated with the NAP1 strain in high organism load group with multiple co-morbidities. Conclusion: High organism load is associated with the presence of NAP1 strain which increases the excessive toxin production leading to poor outcome in elderly patients with multiple underlying co-morbidities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".