Machine learning model for predicting ciprofloxacin resistance and presence of ESBL in patients with UTI in the ED

Abstract

Increasing antimicrobial resistance in uropathogens is a clinical challenge to emergency physicians as antibiotics should be selected before an infecting pathogen or its antibiotic resistance profile is confirmed. We created a predictive model for antibiotic resistance of uropathogens, using machine learning (ML) algorithms. This single-center retrospective study evaluated patients diagnosed with urinary tract infection (UTI) in the emergency department (ED) between January 2020 and June 2021. Thirty-nine variables were used to train the model to predict resistance to ciprofloxacin and the presence of urinary pathogens’ extended-spectrum beta-lactamases. The model was built with Gradient-Boosted Decision Tree (GBDT) with performance evaluation. Also, we visualized feature importance using SHapely Additive exPlanations. After two-step customization of threshold adjustment and feature selection, the final model was compared with that of the original prescribers in the emergency department (ED) according to the ineffectiveness of the antibiotic selected. The probability of using ineffective antibiotics in the ED was significantly lowered by 20% in our GBDT model through customization of the decision threshold. Moreover, we could narrow the number of predictors down to twenty and five variables with high importance while maintaining similar model performance. An ML model is potentially useful for predicting antibiotic resistance improving the effectiveness of empirical antimicrobial treatment in patients with UTI in the ED. The model could be a point-of-care decision support tool to guide clinicians toward individualized antibiotic prescriptions.