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Vihta KD, Pritchard E, Pouwels KB, Hopkins S, Guy RL, Henderson K, Chudasama D, Hope R, Muller-Pebody B, Walker AS, Clifton D, Eyre DW. Predicting future hospital antimicrobial resistance prevalence using machine learning. COMMUNICATIONS MEDICINE 2024; 4:197. [PMID: 39390045 DOI: 10.1038/s43856-024-00606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 09/04/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Predicting antimicrobial resistance (AMR), a top global health threat, nationwide at an aggregate hospital level could help target interventions. Using machine learning, we exploit historical AMR and antimicrobial usage to predict future AMR. METHODS Antimicrobial use and AMR prevalence in bloodstream infections in hospitals in England were obtained per hospital group (Trust) and financial year (FY, April-March) for 22 pathogen-antibiotic combinations (FY2016-2017 to FY2021-2022). Extreme Gradient Boosting (XGBoost) model predictions were compared to the previous value taken forwards, the difference between the previous two years taken forwards and linear trend forecasting (LTF). XGBoost feature importances were calculated to aid interpretability. RESULTS Here we show that XGBoost models achieve the best predictive performance. Relatively limited year-to-year variability in AMR prevalence within Trust-pathogen-antibiotic combinations means previous value taken forwards also achieves a low mean absolute error (MAE), similar to or slightly higher than XGBoost. Using the difference between the previous two years taken forward or LTF performs consistently worse. XGBoost considerably outperforms all other methods in Trusts with a larger change in AMR prevalence from FY2020-2021 (last training year) to FY2021-2022 (held-out test set). Feature importance values indicate that besides historical resistance to the same pathogen-antibiotic combination as the outcome, complex relationships between resistance in different pathogens to the same antibiotic/antibiotic class and usage are exploited for predictions. These are generally among the top ten features ranked according to their mean absolute SHAP values. CONCLUSIONS Year-to-year resistance has generally changed little within Trust-pathogen-antibiotic combinations. In those with larger changes, XGBoost models can improve predictions, enabling informed decisions, efficient resource allocation, and targeted interventions.
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Affiliation(s)
- Karina-Doris Vihta
- Modernising Medical Microbiology, Experimental Medicine, Nuffield Department of Medicine, Level 7 Research Offices, John Radcliffe Hospital, Headley Way, University of Oxford, Oxford, UK.
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK.
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
| | - Emma Pritchard
- Modernising Medical Microbiology, Experimental Medicine, Nuffield Department of Medicine, Level 7 Research Offices, John Radcliffe Hospital, Headley Way, University of Oxford, Oxford, UK
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
| | - Koen B Pouwels
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan Hopkins
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Rebecca L Guy
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Katherine Henderson
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Dimple Chudasama
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Russell Hope
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Berit Muller-Pebody
- Healthcare-associated infections, Fungal, Antimicrobial resistance, Antimicrobial usage, & Sepsis Division, UK Health Security Agency, London, UK
| | - Ann Sarah Walker
- Modernising Medical Microbiology, Experimental Medicine, Nuffield Department of Medicine, Level 7 Research Offices, John Radcliffe Hospital, Headley Way, University of Oxford, Oxford, UK
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - David Clifton
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
- OSCAR (Oxford Suzhou Centre for Advanced Research), University of Oxford, Suzhou, China
| | - David W Eyre
- Modernising Medical Microbiology, Experimental Medicine, Nuffield Department of Medicine, Level 7 Research Offices, John Radcliffe Hospital, Headley Way, University of Oxford, Oxford, UK
- The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- The National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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Iskandar K, Murugaiyan J, Hammoudi Halat D, Hage SE, Chibabhai V, Adukkadukkam S, Roques C, Molinier L, Salameh P, Van Dongen M. Antibiotic Discovery and Resistance: The Chase and the Race. Antibiotics (Basel) 2022; 11:182. [PMID: 35203785 PMCID: PMC8868473 DOI: 10.3390/antibiotics11020182] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The history of antimicrobial resistance (AMR) evolution and the diversity of the environmental resistome indicate that AMR is an ancient natural phenomenon. Acquired resistance is a public health concern influenced by the anthropogenic use of antibiotics, leading to the selection of resistant genes. Data show that AMR is spreading globally at different rates, outpacing all efforts to mitigate this crisis. The search for new antibiotic classes is one of the key strategies in the fight against AMR. Since the 1980s, newly marketed antibiotics were either modifications or improvements of known molecules. The World Health Organization (WHO) describes the current pipeline as bleak, and warns about the scarcity of new leads. A quantitative and qualitative analysis of the pre-clinical and clinical pipeline indicates that few antibiotics may reach the market in a few years, predominantly not those that fit the innovative requirements to tackle the challenging spread of AMR. Diversity and innovation are the mainstays to cope with the rapid evolution of AMR. The discovery and development of antibiotics must address resistance to old and novel antibiotics. Here, we review the history and challenges of antibiotics discovery and describe different innovative new leads mechanisms expected to replenish the pipeline, while maintaining a promising possibility to shift the chase and the race between the spread of AMR, preserving antibiotic effectiveness, and meeting innovative leads requirements.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1295, 31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Pharmacy, Lebanese University, Beirut 6573, Lebanon
| | - Jayaseelan Murugaiyan
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Dalal Hammoudi Halat
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa Campus, Beirut 1103, Lebanon
| | - Said El Hage
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
| | - Vindana Chibabhai
- Division of Clinical Microbiology and Infectious Diseases, School of Pathology, University of the Witwatersrand, Johannesburg 2193, South Africa;
- Microbiology Laboratory, National Health Laboratory Service, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg 2193, South Africa
| | - Saranya Adukkadukkam
- Department of Biological Sciences, SRM University–AP, Amaravati 522502, India; (J.M.); (S.A.)
| | - Christine Roques
- Laboratoire de Génie Chimique, Department of Bioprocédés et Systèmes Microbiens, Université Paul Sabtier, Toulouse III, UMR 5503, 31330 Toulouse, France;
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1295, Université Paul Sabatier Toulouse III, 31000 Toulouse, France;
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573, Lebanon;
- Faculty of Medicine, Lebanese University, Beirut 6573, Lebanon;
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2408, Cyprus
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