Independent Risk Factors for Recurrence of Clostridium difficile Infection: A Canadian Multicenter Prospective Cohort
Bibliographic record
Abstract
Background. Outbreaks of Clostridium difficile infection (CDI) were common in Canadian hospitals since the last decade. CDI causes 20-30% of nosocomial antibiotic-associated diarrhea and up to 22% of patients could experience a recurrence of CDI (rCDI). We identified risk factors for rCDI in a prospective multicenter study. Methods. We conducted a prospective cohort study of adult inpatients with confirmed CDI in 10 acute-care hospitals across Quebec and Ontario, Canada, with 90-day follow-up (2005-2008). CDI was defined by diarrhea and the detection of CD toxin by EIA or direct cytotoxin assay. rCDI was defined as diarrhea and a positive toxin, or receipt of CDI treatment 48 h or more after the completion of initial treatment. Potential risk factors for rCDI were measured at enrollment. Isolates were typed with PCR ribotyping. Risk factors were identified using survival analysis and multivariate Cox hazards modeling. Results. A total of 1380 patients with CDI were enrolled (median age 71 years; IQR = 58-80), among whom 86% were experiencing a primary episode. Most CDI were healthcare facility-associated (90%). Metronidazole was used as treatment for 82% of patients. A stool specimen was collected in 1054 patients, a ribotype was obtained in 922 (67%), and 483 (52%) were R027. At least one rCDI was experienced by 322 patients (23.5%) during a median of 28 days (IQR = 20-40) after the initial episode. Independent risk factors for rCDI were age over 80 years (Adjusted hazards ratio [AHR] = 1.4; 95% CI = 1.06-1.9), duration of hospitalization ≥14 days after CDI diagnosis (AHR = 1.5; 95% CI = 1.14-2.0), C-reactive protein (CRP) ≥150 mg/L (AHR = 1.6; 95% CI = 1.05-2.6), and R027 (AHR = 1.5; 95% CI = 1.1-2.0). Underlying diseases (including immunosuppression), previous exposures, use of concomitant antibiotics or proton pump inhibitors, and other ribotypes were not associated with rCDI in multivariate analysis. Conclusion. Within this large prospective multicenter cohort, older age, increased CRP, ribotype 027, and prolonged hospital stay were associated with rCDI.This study reinforces the association between R027 and rCDI. It demonstrates the need to investigate further the biological basis for relapse in these strains. Disclosures. L. Valiquette, Cubist/Optimer: Grant Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium. Pfizer: Grant Investigator, Research grant. Merck: Grant 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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".