Machine learning to predict antimicrobial resistance: future applications in clinical practice?

Machine learning (ML) is increasingly being used to predict antimicrobial resistance (AMR). This review aims to provide physicians with an overview of the literature on ML as a means of AMR prediction. References for this review were identified through searches of MEDLINE/PubMed, EMBASE, Google Scholar, ACM Digital Library, and IEEE Xplore Digital Library up to December 2023. Thirty-six studies were included in this review. Thirty-two studies (32/36, 89%) were based on hospital data and four (4/36, 11%) on outpatient data. The vast majority of them were conducted in high-resource settings (33/36, 92%). Twenty-four (24/36, 67%) studies developed systems to predict drug resistance in infected patients, eight (n=8/36, 22%) tested the performances of ML-assisted antibiotic prescription, two (n=2/36, 6%) assessed ML performances in predicting colonization with carbapenem-resistant bacteria and, finally, two assessed national and international AMR trends. The most common inputs were demographic characteristics (25/36, 70%), previous antibiotic susceptibility testing (19/36, 53%) and prior antibiotic exposure (15/36, 42%). Thirty-three (92%) studies targeted prediction of Gram-negative bacteria (GNB) resistance as an output (92%). The studies included showed moderate to high performances, with AUROC ranging from 0.56 to 0.93. ML can potentially provide valuable assistance in AMR prediction. Although the literature on this topic is growing, future studies are needed to design, implement, and evaluate the use and impact of ML decision support systems.

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Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.