{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:30:03Z","timestamp":1789212603198,"version":"build-2803163510"},"reference-count":18,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T00:00:00Z","timestamp":1592438400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X20002135_as11\" sec-type=\"other\"><jats:title>Objective:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20002135_as1\" sec-type=\"other\"><jats:title>Methods:<\/jats:title><jats:p>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\u2019s 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.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20002135_as2\" sec-type=\"other\"><jats:title>Results:<\/jats:title><jats:p>Both the logistic regression and boosted-tree models demonstrated fair discriminatory power with AUROCs of 0.73 (95% confidence interval [CI], 0.69\u20130.77) and 0.75 (95% CI, 0.72\u20130.79), respectively (<jats:italic>P<\/jats:italic> = .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\u201345.5 for models tuned to a sensitivity of 85%).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20002135_as3\" sec-type=\"other\"><jats:title>Conclusions:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.213","type":"journal-article","created":{"date-parts":[[2020,6,18]],"date-time":"2020-06-18T12:08:16Z","timestamp":1592482096000},"page":"1022-1027","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":26,"title":["Machine learning for the prediction of antimicrobial stewardship intervention in hospitalized patients receiving broad-spectrum agents"],"prefix":"10.1017","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8404-5470","authenticated-orcid":false,"given":"Rachel J.","family":"Bystritsky","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Beltran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert T.","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah B.","family":"Doernberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,6,18]]},"reference":[{"key":"S0899823X20002135_ref10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.001593"},{"key":"S0899823X20002135_ref8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy255"},{"key":"S0899823X20002135_ref9","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-022666"},{"key":"S0899823X20002135_ref5","first-page":"537","article-title":"What is the more effective antibiotic stewardship intervention: preprescription authorization or postprescription review with feedback?","volume":"64","author":"Tamma","year":"2017","journal-title":"Clin Infect Dis"},{"key":"S0899823X20002135_ref7","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"2","author":"Davey","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"S0899823X20002135_ref15","doi-asserted-by":"publisher","DOI":"10.1162\/089976698300017197"},{"key":"S0899823X20002135_ref17","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.0508-17.2018"},{"key":"S0899823X20002135_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2014.08.015"},{"key":"S0899823X20002135_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.8.972"},{"key":"S0899823X20002135_ref2","doi-asserted-by":"publisher","DOI":"10.1086\/664771"},{"key":"S0899823X20002135_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw118"},{"key":"S0899823X20002135_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofy314"},{"key":"S0899823X20002135_ref11","first-page":"ciy883","article-title":"Cross-sectional whole-genome sequencing and epidemiological study of multidrug-resistant Mycobacterium tuberculosis in China","author":"Huang","year":"2018","journal-title":"Clin Infect Dis"},{"key":"S0899823X20002135_ref12","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.176"},{"key":"S0899823X20002135_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.02.027"},{"key":"S0899823X20002135_ref18","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4939-8561-6_14"},{"key":"S0899823X20002135_ref13","doi-asserted-by":"publisher","DOI":"10.1175\/1520-0493(1950)078<0001:VOFEIT>2.0.CO;2"},{"key":"S0899823X20002135_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l886"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20002135","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T08:13:38Z","timestamp":1600157618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20002135\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,18]]},"references-count":18,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["S0899823X20002135"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.213","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,18]]},"assertion":[{"value":"\u00a9 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}