Bibliographic record
Abstract
The epidemiology, clinical severity and case-fatality ratio of Clostridium difficile infection (CDI) changed dramatically with the emergence of a toxin hyperproducing strain (BI/NAP1/027) in North America and Europe since 2000. These changes have stimulated the quest for novel therapeutic approaches, and a re-examination of the comparative efficacy of metronidazole versus oral vancomycin. Unfortunately, tolevamer, the only novel treatment evaluated so far in phase 3 trials, has proven inferior to comparators, and metronidazole and vancomycin remain the two most commonly used drugs. The major advantage of metronidazole is its low price. The major advantage of orally administered vancomycin lies in its more favorable pharmacokinetics. Facilitating vancomycin-resistant enterococci colonization/infection is a potential drawback of both drugs. The randomized controlled trials published so far used intermediate outcomes rather than outcomes that now preoccupy clinicians: the frequency of complications or recurrences. Pending the development of a prospectively validated scoring system, the IDSA/SHEA expert committee will define severe CDI as any patient with a leukocytosis ≥15000/mm3 or a creatinine increased by ≥50% from baseline. For patients with mild-to moderate CDI (leukocytosis <15000/mm3 and creatinine <1.5 X baseline), there is no evidence that vancomycin is superior to metronidazole (even for intermediate outcomes), and metronidazole should be preferred. For patients with severe CDI not infected with BI/NAP1/027, there is reasonable evidence that the better pharmacokinetics of vancomycin translate into a lower probability of complications. For those infected with BI/NAP1/027, the superiority of vancomycin remains to be proven. About one fourth of patients treated with either metronidazole or vancomycin will experience at least one recurrence. There is now some evidence that the more common post-metronidazole recurrences documented recently in some centers may have corresponded to re-infections among patients who remained exposed in the hospital environment.
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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 | 0.012 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.006 | 0.014 |
| Open science | 0.004 | 0.006 |
| Research integrity | 0.007 | 0.021 |
| Insufficient payload (model declined to judge) | 0.018 | 0.006 |
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".