525Epidemiology and burden of recurrent Clostridium difficile infections
Bibliographic record
Abstract
Background. Clostridium difficile infection (CDI) is associated with a 22% recurrence rate. However, few studies have focused on multiple recurrences. In order to evaluate the potential of new treatment options targeting specifically recurrences, we assessed the burden of recurrent Clostridium difficile infections (rCDI). Methods. A retrospective cohort of all adults diagnosed with CDI between 1998 and 2009, identified by a positive cytotoxin assay and ICD-9 CM/10 codes, living in the Sherbrooke area (Quebec, Canada). An rCDI was defined by the reappearance of diarrhea leading to a treatment, with or without a positive toxin assay or an endoscopic evidence of pseudomembranous colitis, within 14 to 60 days following the previous episode. Results. A total of 1311 patients were included (median age = 72.4 years; IQR = 54-82). Initial CDI was nosocomial in 35% of cases, followed a previous admission in 22%, and was community-acquired in 44%. The probability of having a first rCDI was 24% (291/1214) excluding deaths and total colectomies within 60 days, a second rCDI 41.3% (105/254), a third 33.3% (31/93), and a fourth or more 24.1% (7/29). Burden of rCDI (n(%)) *excluding patients already hospitalized Conclusion. This study addresses multiple recurrences of both community and hospital-acquired CDI, and demonstrates its substantial burden on health care resources. After each CDI, almost one third of patients needed admission, one fourth developed severe CDI and over 5% developed a complication. Disclosures. J. Pepin, Cubist/Optimer: Investigator, Research grant L. Valiquette, Cubist: Consultant, Investigator and Speaker's Bureau, Consulting fee, Educational grant, Research grant and Speaker honorarium; Pfizer: Consultant and Investigator, Consulting fee and Research support; Merck: Investigator, Research grant
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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 | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".