Bibliographic record
Abstract
Introduction: To evaluate clinical outcomes of Clostridum difficile infection (CDI) treatment with monotherapy, either oral or intravenous metronidazole or oral vancomycin, as compared to combination therapy with both antibiotics when stratified by disease severity Hypothesis: Patients treated with combination therapy will have better outcomes than those treated with monotherapy Methods: This retrospective study stratified subjects by type of treatment and CDI severity. The primary end point was time to clinical improvement. Secondary endpoints included: rate of recurrence, incidence of CDI-related complications, rate of antibiotic failure and appropriateness of initial drug therapy. Data collected included: patient demographics, CDI risk factors, drug regimen specific data and clinical, laboratory and radiologic parameters Results: Monotherapy and combination therapy were utilized in 76 and 33 patients, respectively. A total of 74 patients were > 65 years and 32% were critically ill. APACHE two scores in the 2 groups were comparable (15.1 ± 6.6 vs. 17.9 ± 8.8; p = 0.171). The most common risk factors associated with CDI were recent antibiotic exposure (86%) and use of acid suppression therapy (67%). Subjects assigned to monotherapy had a shorter time to clinical improvement than subjects with combination therapy (5.4 ± 3.2 days vs. 7.9 ± 5.1 days; p = 0.0018). In the severe disease subgroup (22% of study population) the difference was 4.6 ± 1.5 days vs. 8.2 ± 4.9 days; p = 0.049. Monotherapy patients experienced fewer CDI-related complications (11.8% vs. 36.4%; p = 0.008). Although not statistically significant, there was a lower antibiotic failure rate (17.1% vs. 27.3%; p = 0.299) but a higher incidence of recurrence at 3 months (36.8% vs. 24.2%; p = 0.268) with montherapy. Finally, 49% of patients in the monotherapy and 58% in the combination therapy were started on an inappropriate initial CDI treatment regimen (p = 0.413) based on disease severity Conclusions: Contrary to our hypothesis, patients receiving combination therapy had a longer time to CDI resolution compared to subjects receiving monotherapy. The more pronounced difference in the severe disease subgroup warrants further investigation.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.545 | 0.413 |
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".