495. Predictors of <i>C. difficile</i> Infection and Impact of Primary Prophylaxis Among Asymptomatic <i>C. difficile</i> Colonized Patients: A Cross-Sectional Study
Bibliographic record
Abstract
Patients who are colonized with C. difficile are at risk of developing C. difficile infections (CDI), but factors associated with disease onset are poorly understood. The objectives of this study were to identify predictors of hospital-onset CDI (HO-CDI) among asymptomatic C. difficile colonized patients and explore the potential benefit of primary prophylaxis to prevent CDI. We performed a retrospective cross-sectional study of C. difficile colonized patients admitted to a tertiary academic institution in Quebec City between November 2013 and January 2017. Colonization status was determined upon hospital admission through a systematic screening program by detecting the TcdB gene by PCR on a rectal swab. Primary prophylaxis was defined as the preventive use of ≥1 dose of oral vancomycin or metronidazole in a patient without diarrhea. The choice and dosing of prophylaxis were left to the discretion of the treating physician. Univariate and multivariate logistic regression analyses were used to determine independent predictors of HO-CDI. Of 513 C. difficile colonized patients, 39 (7.6%) developed a HO-CDI, with a 30-day attributable mortality of 18%. We found that an increased length of hospital stay (adjusted odds ratio [aOR] per day, 1.03; P = 0.006), exposure to multiple classes of systemic antibiotics (aOR per class of antibiotic, 1.45; P = 0.03), the use of opioid analgesics (aOR, 2.70; P = 0.01) and cirrhosis (aOR, 5.57; P = 0.007), were independently associated with an increased risk of HO-CDI in multivariate analysis, whereas the use of laxatives was associated with a lower risk of CDI (aOR, 0.36; P = 0.01). Among the antimicrobials, B-lactam with B-lactamase inhibitors (OR, 3.65; P < 0.001), first-generation cephalosporins (OR, 2.38; P = 0.03), and carbapenems (OR, 2.44; P = 0.03) correlated with the greatest risk of HO-CDI. In contrast, patient age, exposure to proton pump inhibitors, and the use of prophylaxis were not significantly associated with occurrence of HO-CDI in this specific population. This study identifies several variables that are specifically associated with the development of CDI among C. difficile colonized patients. Whether modifying these risk factors could help prevent CDI should be further investigated. S. Trottier, CIHR: Grant Investigator, Research grant. V. Loo, Merck: Consultant and Scientific Advisor, Consulting fee. Y. Longtin, Merck: Grant Investigator, Research grant. Becton Dickinson: Grant Investigator, Grant recipient.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 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".