Role of patient descriptors in predicting antimicrobial resistance in urinary tract infections using a decision tree approach: A retrospective cohort study
Abstract
BACKGROUND
In general practice, many infections are treated empirically prior to or without microbiological confirmation. Prediction of antimicrobial susceptibility could optimise prescribing thus improving patient outcomes. Decision tree models are a novel idea to predict AMR at the time of clinical presentation. This study aims to apply a prediction model using a decision tree approach to predict the antimicrobial resistance (AMR) of pathogens causing urinary tract infections (UTI) for patients over 65 years based on pre-existing routine laboratory data.
METHODS
Data were extracted from the database of the microbiological laboratory of the University Hospitals Galway (UHG). All urine results from patients over 65 years, their microbiological analysis and susceptibility (AST) results from January 2011 to December 2015 were included. The primary endpoint was culture result and resistance to antimicrobials (nitrofurantoin, trimethoprim, ciprofloxacin, co-amoxiclav, and amoxicillin) commonly used to treat UTI. A non-parametric regression tree analysis i.e. a decision tree model was generated with the 75% of the dataset (training set) and validated with the remaining 25% (test set). The model performance was evaluated measuring Area Under the Curve Receiver Operating Characteristic (AUC_ROC) curve.
RESULTS
A total of 99,101 urine samples of patients over 65 years were submitted for culture over the five years and 27% had significant bacteriuria (≥104 cfu/ml) and AST. The most…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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