Is There a Role for Antimicrobial Stewardship in Cystic Fibrosis?
Bibliographic record
Abstract
There is currently considerable interest in developing antimicrobial stewardship programs in pediatric and adult acute and chronic care hospitals as a method of preserving the activity of existing antimicrobial agents against an increasing number of multidrug-resistant organisms. Cystic fibrosis (CF) is recognized as one of the conditions associated with the highest use of antimicrobials in pediatrics and has thus been identified as a potential target of antimicrobial stewardship programs. The benefits of aggressive antibiotic use to treat pulmonary infections in individuals with CF are well defined and it is not always possible to follow the stewardship principle of narrowing antimicrobial spectrum based on susceptibility testing and treating with short antibiotic courses. However, antimicrobial stewardship still has a role to play in CF. There are practical solutions that can be currently applied. For chronic suppressive antimicrobial therapy, aerosolization is the most effective route, achieving high intrapulmonary concentrations with few systemic toxicities. Given the absence of evidence demonstrating benefit, prolonged intravenous and oral antibiotic courses should generally be avoided. Increasing the number of antibiotics does not necessarily confer a clinical advantage; trials of cycling different antibiotics should be studied as it may have potential benefits both regarding efficacy and development of resistance. Further research is clearly needed in this area to optimize the antibiotic management of this population.
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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 | 0.011 | 0.034 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.008 |
| Scholarly communication | 0.005 | 0.009 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.009 | 0.009 |
| Insufficient payload (model declined to judge) | 0.011 | 0.002 |
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".