Asymptomatic C. difficile Colonization: A Potential Source of Infection in an Inpatient Urban Hospital Service
Bibliographic record
Abstract
Introduction: Several recent studies have shown that asymptomatic carriage ofthe nosocomial pathogen Clostridium difficile exists in inpatient medical facilities and may be a reservoir for its infection and transmission1. Despite efforts in antibiotic stewardship, cases of hospital-acquired C. difficile infection (CDI) persist. Addressing the problem requires looking at all potential sources of infection, including these spore-spreading asymptomatic carriers. The objective of our study was to determine the prevalence of hospital carriers and their demographic characteristics. Methods: We performed an observational study and screened patients on two inpatient units at an urban university teaching hospital. Eligible patients were not diagnosed with CDI and had not previously been tested. Patients gave IRB approved informed consent and their stool was collected. We tested stool using Cepheid's Xpert C. difficile qPCR assay, which detects genes for Toxin B, binary toxin, and tcdC deletion. Demographic and medical information was recorded from EMR review. Results: We examined stool from 50 asymptomatic inpatients and found a carriage rate of 10%. We used Fisher Exact Test of independence to determine whether carrier status depended on demographics or medical history. We found an association between insurance and carrier status, with more carriers on commercial insurance rather than Medicare or Medicaid (P=0.005). We also found an association, though non-significant, between race and carrier status, as all carriers were white (P=0.059). Conclusion: We have found a 10% carriage rate in our study of asymptomatic, urban teaching- hospital inpatients. This population, with a higher rate than we anticipated from other published studies from Canada and Europe, may be an additional, significant reservoir of C. difficile that could explain the continued prevalence of this infection.
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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 | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".