Strategies to Prevent <i>Clostridium difficile</i> Infections in Acute Care Hospitals: 2014 Update
Bibliographic record
Abstract
strategies to prevent cdi: 2014 update 629 deletions and carries binary toxin), has been reported to have a higher 14-day mortality in the United Kingdom than BI/NAP1/027. 23In the United Kingdom, the BI/ NAP1/027 strain is no longer the predominant strain, and it occurs less frequently in continental Europe. 7In the United States, the prevalence of the BI/NAP1/027 strain averages approximately 25%-35% of CDI cases but ranges from 28% to 85% in adults. [24][25]][26] II.Outcomes associated with CDI CDI is associated with increased length of hospital stay, costs, morbidity, and mortality in adult and pediatric patients. [27][28]][29][30] A. CDI increases hospital length of stay by 2.8 to 5.5 days. 28B. Attributable costs of inpatient CDI in 2008 dollars have been estimated to be $3,006-$15,397 per episode. 28US hospital costs for CDI management have been estimated to be $1.0-4.9 billion per year. 28Costs of CDI in the outpatient and non-acute care settings have not been assessed.C. Patients with CDI were almost twice as likely to be discharged to a long-term care facility than propensity score-matched controls. 27D. The attributable mortality of CDI is estimated to be 5%-10%, 8,9,23,27 leading to an estimated 14,000-20,000 deaths attributable to CDI in the United States each year. 14,29III.Changing risk factors and possible decrease in CDI treatment response rates A. For the past 10 years, fluoroquinolones, previously infrequently associated with CDI, have been found to be one of the primary precipitating antimicrobials in recent studies. 19,311. Virtually every antibiotic has been associated with CDI.Cephalosporins, ampicillin, and clindamycin remain important predisposing antibiotics. 15B. Gastric acid suppression has been recognized as a risk factor for CDI in some studies. 151.Some studies suggest that the association between gastric acid suppression and CDI is related to other important risk factors, such as severity of illness and age. 312. Gastric acid suppression may be an important risk factor for CDI outside healthcare facilities. 32C. Several studies suggest that rates of response to treatment of CDI with metronidazole are declining, including a randomized, prospective, blinded, severity-stratified study that demonstrated statistically superior rates of response to vancomycin for severe disease but not for mild disease compared with metronidazole. [33][34][35] section 2: background-strategies to detect cdi I. Surveillance definitions Definitions for CDI surveillance in the United States and Europe have been published. 36,
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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 | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| 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".