Using interpretable machine learning to predict bloodstream infection and antimicrobial resistance in patients admitted to ICU: Early alert predictors based on EHR data to guide antimicrobial stewardship

Nosocomial infections and Antimicrobial Resistance (AMR) stand as formidable healthcare challenges on a global scale. To address these issues, various infection control protocols and personalized treatment strategies, guided by laboratory tests, aim to detect bloodstream infections (BSI) and assess the potential for AMR. In this study, we introduce a machine learning (ML) approach based on Multi-Objective Symbolic Regression (MOSR), an evolutionary approach to create ML models in the form of readable mathematical equations in a multi-objective way to overcome the limitation of standard single-objective approaches. This method leverages readily available clinical data collected upon admission to intensive care units, with the goal of predicting the presence of BSI and AMR. We further assess its performance by comparing it to established ML algorithms using both naturally imbalanced real-world data and data that has been balanced through oversampling techniques. Our findings reveal that traditional ML models exhibit subpar performance across all training scenarios. In contrast, MOSR, specifically configured to minimize false negatives by optimizing also for the F1-Score, outperforms other ML algorithms and consistently delivers reliable results, irrespective of the training set balance with F1-Score.22 and.28 higher than any other alternative. This research signifies a promising path forward in enhancing Antimicrobial Stewardship (AMS) strategies. Notably, the MOSR approach can be readily implemented on a large scale, offering a new ML tool to find solutions to these critical healthcare issues affected by limited data availability.Author summary: This study confronts the global healthcare challenges posed by hospital-acquired infections and antibiotic resistance. It introduces an innovative machine learning approach known as Multi-Objective Symbolic Regression (MOSR), designed to predict bloodstream infections and evaluate antibiotic resistance risks using readily available clinical data from intensive care unit admissions. Unlike conventional models, MOSR consistently outperforms its counterparts, delivering reliable results even when faced with data imbalances. This advancement holds significant promise for enhancing Antimicrobial Stewardship (AMS) strategies, potentially curbing the unnecessary use of antibiotics. The simplicity and scalability of MOSR indicate its potential for widespread implementation, offering a robust solution to address these critical healthcare issues on a larger scale and ultimately improve patient outcomes.