<i>Clostridium difficile</i> in Clinical Practice: Increasing Rates, More Virulent Organisms and New Therapies on the Horizon
Bibliographic record
Abstract
Clostridium difficile‐associated diarrhea has recently come under increasing scrutiny because of outbreaks of disease in eastern Canada in association with a hypervirulent ribotype 027 (NAP1) strain. Hospitals in the United States, the United Kingdom and Europe have been affected as well. Epidemiological studies are underway to determine the presence of the more virulent strain of C difficile in hospitals across Canada. Because this strain is highly quinolone resistant, it is suspected that overuse of that class of antimicrobial agent may be a selection factor for this strain. Although C difficile‐associated diarrhea is usually considered a nosocomial infection, approximately one‐quarter of cases occur in the community. Recurrence following successful resolution of diarrhea occurs in one in five patients treated with metronidazole or vancomycin; relapse is more common in patients needing retreatment. New therapies that may have equivalent or higher response rates and lower recurrence rates are being investigated. It is hoped that these new treatments will be a substantial improvement over current therapies. In the interim, prudent antimicrobial use and attention to infection control practices are the main preventive strategies. Prompt testing for C difficile toxin in patients with diarrhea after antibiotic exposure, discontinuation of unnecessary antibiotic therapy and rapid initiation of treatment should minimize complications. With the appearance of more toxigenic strains of C difficile, careful monitoring of patients to detect suboptimal clinical response is necessary.
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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 | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.001 | 0.005 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.008 | 0.005 |
| Insufficient payload (model declined to judge) | 0.020 | 0.005 |
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".