Investigating in-hospital transmission of <i>Clostridioides difficile</i> from asymptomatic patients
Bibliographic record
Abstract
Background: Clostridioides difficile is a bacillus that can colonize the intestinal tract. C. difficile infection (CDI) is a common, health care–associated disease often coinciding with antibiotic use, with presentation ranging from diarrhea to toxic megacolon and death. However, individuals can carry the pathogen without exhibiting symptoms of disease. C. difficile carriers may serve as an important reservoir for in-hospital transmission of C. difficile. The objective of this study was to assess the role asymptomatic C. difficile carriers may play in pathogen transmission. Methods: In this retrospective cohort study, rectal swabs collected to test for antimicrobial-resistant organisms either upon admission or during the hospital stay were used to test for asymptomatic C. difficile carriage using molecular testing, with positive samples cultured and subsequently sequenced. Sampling occurred across three tertiary care hospitals with predominantly multi-bedded rooms. A whole-genome single-nucleotide variant phylogenetic tree was then constructed and closely related samples from patients that had spatial and temporal in-hospital overlap were identified as putative transmission events. Results: Approximately 11% of the 1,467 patients tested were carriers of C. difficile. Seventy-four of the carriers were culture-positive, of which 43 had a suitable sequence for typing. Of the sequenced samples, 40% were identified as belonging to a potential transmission event. Six different potential transmission groups were identified, with the largest putative transmission group spanning two hospitals and 6 months. Conclusions: Our results suggest that asymptomatic transmission in hospital settings may be much more common than previously thought, with asymptomatic individuals colonized with C. difficile providing a sizable source of transmission of the pathogen.
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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 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".