Machine learning for the prediction of antimicrobial stewardship intervention in hospitalized patients receiving broad-spectrum agents
| العنوان: | Machine learning for the prediction of antimicrobial stewardship intervention in hospitalized patients receiving broad-spectrum agents |
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| المؤلفون: | Albert T. Young, Xiao Hu, Rachel Bystritsky, Sarah B Doernberg, Alex Beltran, Andrew D. Wong |
| المصدر: | Infection control and hospital epidemiology. 41(9) |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Microbiology (medical), medicine.medical_specialty, Epidemiology, Logistic regression, Machine Learning, 03 medical and health sciences, Antimicrobial Stewardship, 0302 clinical medicine, Anti-Infective Agents, medicine, Antimicrobial stewardship, Humans, 030212 general & internal medicine, Medical prescription, Retrospective Studies, 0303 health sciences, Receiver operating characteristic, 030306 microbiology, business.industry, Retrospective cohort study, Antimicrobial, Confidence interval, Anti-Bacterial Agents, Infectious Diseases, Emergency medicine, Stewardship, business |
| الوصف: | Objective:A significant proportion of inpatient antimicrobial prescriptions are inappropriate. Post-prescription review with feedback has been shown to be an effective means of reducing inappropriate antimicrobial use. However, implementation is resource intensive. Our aim was to evaluate the performance of traditional statistical models and machine-learning models designed to predict which patients receiving broad-spectrum antibiotics require a stewardship intervention.Methods:We performed a single-center retrospective cohort study of inpatients who received an antimicrobial tracked by the antimicrobial stewardship program. Data were extracted from the electronic medical record and were used to develop logistic regression and boosted-tree models to predict whether antibiotic therapy required stewardship intervention on any given day as compared to the criterion standard of note left by the antimicrobial stewardship team in the patient’s chart. We measured the performance of these models using area under the receiver operating characteristic curves (AUROC), and we evaluated it using a hold-out validation cohort.Results:Both the logistic regression and boosted-tree models demonstrated fair discriminatory power with AUROCs of 0.73 (95% confidence interval [CI], 0.69–0.77) and 0.75 (95% CI, 0.72–0.79), respectively (P = .07). Both models demonstrated good calibration. The number of patients that would need to be reviewed to identify 1 patient who required stewardship intervention was high for both models (41.7–45.5 for models tuned to a sensitivity of 85%).Conclusions:Complex models can be developed to predict which patients require a stewardship intervention. However, further work is required to develop models with adequate discriminatory power to be applicable to real-world antimicrobial stewardship practice. |
| تدمد: | 1559-6834 0899-823X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::171f4c0ec61c7fb4e8a7dd93488923e3 https://pubmed.ncbi.nlm.nih.gov/32618533 |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....171f4c0ec61c7fb4e8a7dd93488923e3 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15596834 0899823X |
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