Using Routine Asymptomatic <i>Clostridioides difficile</i> Testing to Identify Patients at High Risk of Developing <i>Clostridioides difficile</i> Infection During Hematopoietic Cell Transplantation
Bibliographic record
Abstract
Background: Colonization with enteropathogens such as Clostridioides difficile ( C. difficile) has been linked to clinical infection with these same organisms. C. difficile infection (CDI) is associated with increased morbidity and mortality in patients undergoing hematopoietic cell transplantation (HCT). The study aims to evaluate the utility of existing C. difficile stool detection methods used during pre-transplant planning to identify individuals at high risk of developing CDI within 3 months post-transplant. Methods: A prospective cohort study of patients undergoing HCT at a large quaternary care centre was conducted to assess the impact of baseline C. difficile colonization on downstream CDI outcomes. Baseline stool samples were collected prior to admission for conditioning chemotherapy, which were evaluated for C. difficile colonization using routine, short–turnaround-time clinical approaches by performing glutamine dehydrogenase (GDH) enzyme immunoassay (EIA) and toxin B gene (tcdB) polymerase chain reaction (PCR). Clinical data and outcomes were reviewed 3 months post-transplant. Test characteristics for using baseline C. difficile colonization as a screening tool for predicting subsequent CDI were calculated. Results: Sixty patients were enrolled. The prevalence of C. difficile colonization (GDH positive) among patients undergoing HCT was 10% (6/60). Ten patients developed CDI within 3 months post-transplant, 50% of whom were colonized at baseline. Among the colonized patients, 83% (5/6) developed CDI during the follow-up period. Asymptomatic C. difficile colonization pre-admission had a 98% specificity (95% CI, 89% to 100%), 50% sensitivity (95% CI, 19% to 81%), 83% positive predictive value (95% CI, 36%–100%), and 91% negative predictive value (95% CI, 80% to 97%) for developing subsequent CDI. Conclusions: Pre-admission C. difficile screening could support targeted prophylactic strategies for patients at risk of developing CDI, and this approach warrants further evaluation.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.001 | 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".