{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:22:42Z","timestamp":1790202162407,"version":"4.1.0"},"reference-count":55,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Inform"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Antibiotic therapies are the main treatment for bacterial infections, but growing antibiotic resistance is a major global health threat, severely impacting patients with sepsis. Rapid selection of the most effective antibiotic therapy is critical for survival and for preventing further resistance. Physicians must consider numerous factors for proper empiric treatment selection. A clinical decision support system (CDSS) aims to support physicians in this process, facilitating rapid and targeted therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this work is to explore the extent to which the realization of a CDSS is possible based on the data available to us and to document insights gained during the development of a foundational model designed to assist physicians in determining empiric treatment options for patients with sepsis. In this regard, rather than aiming to develop a CDSS for clinical application, we highlight the importance of close interprofessional collaboration between scientists from various disciplines and analyze the effects of data quality and quantity on the performance of our statistical models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Empirical scientists conducted interviews with medical practitioners to acquire the medical knowledge required to develop sound statistical models. We developed and applied 2-step cross-sectional, as well as time-series classification models, to carefully preprocessed data of patients with sepsis admitted to the intensive care unit of a German hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified several factors as crucial information for valid decisions on empiric therapy for treating patients with sepsis. These include the patients\u2019 core data, especially the infection focus. To prevent further resistance, individual risk factors such as travel history and professional background should be considered. The evaluation of a therapy\u2019s effectiveness is mainly based on the patient\u2019s general condition and blood values such as procalcitonin and interleukin 6. One key factor in the acceptance of a CDSS is the explainability of the results produced by the applied methods. Our models demonstrated mainly weak predictive ability for all considered empiric antibiotic therapies. However, they are not yet suitable for use in clinical practice, especially as they are based on prescribing habits rather than on optimal treatment decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This work highlights the importance of interprofessional collaboration between medical experts and model developers, ensuring that data quality and clinical relevance are central to the process. It emphasizes the urgent need for high-quality, comprehensive data to overcome challenges such as data discontinuity and improve model performance, particularly through enhanced digitization in health care. This feasibility study will facilitate future efforts to develop a CDSS for treating patients with sepsis and to translate it into clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/79929","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T20:11:23Z","timestamp":1778703083000},"page":"e79929-e79929","source":"Crossref","is-referenced-by-count":3,"title":["Development Process of a Clinical Decision Support System for Empiric Antibiotic Therapies in Patients With Sepsis: Case Study"],"prefix":"10.2196","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9632-3426","authenticated-orcid":false,"given":"Sophie","family":"Schmiegel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0607-6033","authenticated-orcid":false,"given":"Hannah","family":"Marchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7250-6442","authenticated-orcid":false,"given":"Philipp","family":"Hege","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8704-1208","authenticated-orcid":false,"given":"Svenja","family":"Elkenkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5700-4852","authenticated-orcid":false,"given":"Juliane","family":"Duevel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7817-9448","authenticated-orcid":false,"given":"Christoph","family":"D\u00fcsing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9552-6969","authenticated-orcid":false,"given":"Wolfgang","family":"Greiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6567-2022","authenticated-orcid":false,"given":"Sean Selim","family":"Scholz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0315-9327","authenticated-orcid":false,"given":"Dominic","family":"Witzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-6813","authenticated-orcid":false,"given":"Johannes J","family":"Tebbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2405-1596","authenticated-orcid":false,"given":"Michael","family":"Wehmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0784-0034","authenticated-orcid":false,"given":"Olaf","family":"Kaup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2870-745X","authenticated-orcid":false,"given":"Rainer","family":"Borgstedt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5835-7083","authenticated-orcid":false,"given":"Sebastian","family":"Rehberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4771-441X","authenticated-orcid":false,"given":"Philipp","family":"Cimiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3565-8315","authenticated-orcid":false,"given":"Christiane","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"11","key":"R1","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","journal-title":"Intensive Care Med"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/s0025-7125(05)70309-6","article-title":"Antibiotic side effects","volume":"85","author":"Cunha","journal-title":"Med Clin North Am"},{"issue":"4","key":"R3","first-page":"277","volume":"40","author":"Ventola","journal-title":"P T"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1039\/C7MD00528H","article-title":"Narrow-spectrum antibacterial agents","volume":"9","author":"Melander","journal-title":"Medchemcomm"},{"issue":"10325","key":"R5","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","journal-title":"The Lancet"},{"issue":"12 Suppl","key":"R6","doi-asserted-by":"publisher","first-page":"S122","DOI":"10.1038\/nm1145","article-title":"Antibacterial resistance worldwide: causes, challenges and responses","volume":"10","author":"Levy","journal-title":"Nat Med"},{"issue":"10","key":"R7","first-page":"e567","volume":"21","author":"Ebell","journal-title":"Am J Manag Care"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"36","DOI":"10.4103\/jgid.jgid_110_18","article-title":"Global contributors to antibiotic resistance","volume":"11","author":"Chokshi","journal-title":"J Glob Infect Dis"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-025-12777-8","article-title":"Barriers and facilitators to optimal sepsis care - a systematized review of healthcare professionals\u2019 perspectives","volume":"25","author":"Draeger","journal-title":"BMC Health Serv Res"},{"key":"R10","unstructured":"KI-basierte Entscheidungsunterst\u00fctzung zur antibiotika-therapie. KINBIOTICS. URL: https:\/\/kinbiotics.de [Accessed 11-03-2025]"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","DOI":"10.1093\/nargab\/lqaa074","article-title":"Nanopore sequencing of native adeno-associated virus (AAV) single-stranded DNA using a transposase-based rapid protocol","volume":"2","author":"Radukic","journal-title":"NAR Genom Bioinform"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2024.102982","article-title":"Integrating federated learning for improved counterfactual explanations in clinical decision support systems for sepsis therapy","volume":"157","author":"D\u00fcsing","journal-title":"Artif Intell Med"},{"issue":"8","key":"R13","doi-asserted-by":"publisher","first-page":"10","DOI":"10.25646\/12983","article-title":"Modellprojekt zur Antibiotikaresistenz-Surveillance in Ostwestfalen-Lippe","author":"Scherer","journal-title":"Epidemiologisches Bulletin"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/66699","article-title":"An AI-based clinical decision support system for antibiotic therapy in sepsis (KINBIOTICS): use case analysis","volume":"12","author":"D\u00fcvel","journal-title":"JMIR Hum Factors"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-024-02490-7","article-title":"Decision support systems for antibiotic prescription in hospitals: a survey with hospital managers on factors for implementation","volume":"24","author":"Tokg\u00f6z","journal-title":"BMC Med Inform Decis Mak"},{"issue":"10219","key":"R16","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","journal-title":"The Lancet"},{"key":"R17","unstructured":"Improving the prevention, diagnosis and clinical management of sepsis. World Health Assembly (WHA70); 2017. URL: https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA70\/A70_R7-en.pdf [Accessed 01-05-2026]"},{"issue":"8","key":"R18","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","journal-title":"JAMA"},{"key":"R19","unstructured":"World health organization (WHO) executive board. Improving the prevention, diagnosis and clinical management of sepsis; 2017. URL: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/273181\/B140_12-en.pdf?sequence=1&isAllowed=y"},{"issue":"7","key":"R20","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction\/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine","volume":"22","author":"Vincent","journal-title":"Intensive Care Med"},{"issue":"6","key":"R21","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","journal-title":"Crit Care Med"},{"issue":"6","key":"R22","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1007\/s00134-003-1715-1","article-title":"Therapy of ventilator-associated pneumonia. A patient-based approach based on the ten rules of \u201cThe Tarragona Strategy\u201d","volume":"29","author":"Sandiumenge","journal-title":"Intensive Care Med"},{"issue":"4","key":"R23","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1097\/CCM.0000000000002936","article-title":"An interpretable machine learning model for accurate prediction of sepsis in the ICU","volume":"46","author":"Nemati","journal-title":"Crit Care Med"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.754348","article-title":"A machine learning model for accurate prediction of sepsis in ICU patients","volume":"9","author":"Wang","journal-title":"Front Public Health"},{"key":"R25","unstructured":"Moor M Horn M Rieck B Roqueiro D Borgwardt K . Early recognition of sepsis with Gaussian process temporal convolutional networks and dynamic time warping. Presented at: Proceedings of the 4th Machine Learning for Healthcare Conference; Aug 8-10, 2019; Ann Arbor, MI. 2019.URL: https:\/\/proceedings.mlr.press\/v106\/moor19a.html [Accessed 01-05-2026]"},{"issue":"7","key":"R26","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.3390\/electronics9071133","article-title":"Two-stage monitoring of patients in intensive care unit for sepsis prediction using non-overfitted machine learning models","volume":"9","author":"Abromavi\u010dius","journal-title":"Electronics (Basel)"},{"issue":"27","key":"R27","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.ifacol.2018.11.658","article-title":"Hidden Markov models for sepsis classification","volume":"51","author":"Parente","journal-title":"IFAC-PapersOnLine"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.607952","article-title":"Early prediction of sepsis in the ICU using machine learning: a systematic review","volume":"8","author":"Moor","journal-title":"Front Med (Lausanne)"},{"issue":"3","key":"R29","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12030452","article-title":"Using machine learning to predict antimicrobial resistance-a literature review","volume":"12","author":"Sakagianni","journal-title":"Antibiotics (Basel)"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1007\/s40121-021-00438-2","article-title":"Machine learning to assess the risk of multidrug-resistant gram-negative bacilli infections in febrile neutropenic hematological patients","volume":"10","author":"Garcia-Vidal","journal-title":"Infect Dis Ther"},{"issue":"10","key":"R31","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac487","article-title":"Predicting risk of multidrug-resistant enterobacterales infections among people with HIV","volume":"9","author":"Henderson","journal-title":"Open Forum Infect Dis"},{"issue":"2","key":"R32","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics9020050","article-title":"Using machine learning techniques to aid empirical antibiotic therapy decisions in the intensive care unit of a general hospital in Greece","volume":"9","author":"Feretzakis","journal-title":"Antibiotics (Basel)"},{"issue":"11","key":"R33","doi-asserted-by":"publisher","first-page":"e848","DOI":"10.1093\/cid\/ciaa1576","article-title":"Predicting antibiotic resistance in hospitalized patients by applying machine learning to electronic medical records","volume":"72","author":"Lewin-Epstein","journal-title":"Clin Infect Dis"},{"issue":"7","key":"R34","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1007\/s00345-022-04043-x","article-title":"Using machine learning techniques to predict antimicrobial resistance in stone disease patients","volume":"40","author":"Tzelves","journal-title":"World J Urol"},{"issue":"5","key":"R35","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s40121-022-00677-x","article-title":"Development of a prediction model for antibiotic-resistant urinary tract infections using integrated electronic health records from multiple clinics in North-Central Florida","volume":"11","author":"Rich","journal-title":"Infect Dis Ther"},{"issue":"6","key":"R36","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1093\/jac\/dkl372","article-title":"Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial","volume":"58","author":"Paul","journal-title":"J Antimicrob Chemother"},{"key":"R37","unstructured":"World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems (ICD). 2025. URL: https:\/\/www.who.int\/standards\/classifications\/classification-of-diseases [Accessed 08-04-2025]"},{"key":"R38","doi-asserted-by":"crossref","unstructured":"van Buuren S . Flexible Imputation of Missing Data. 2nd ed. Chapman and Hall\/CRC; 2018. [doi: 10.1201\/9780429492259] ISBN: 9780429492259","DOI":"10.1201\/9780429492259"},{"issue":"10","key":"R39","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.1093\/bioinformatics\/btaa046","article-title":"Consensus features nested cross-validation","volume":"36","author":"Parvandeh","journal-title":"Bioinformatics"},{"issue":"1","key":"R40","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jcrc.2010.04.011","article-title":"Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis","volume":"26","author":"Tschaikowsky","journal-title":"J Crit Care"},{"issue":"1","key":"R41","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/4459198","article-title":"Towards risk\u2010free trustworthy artificial intelligence: significance and requirements","volume":"2023","author":"Alzubaidi","journal-title":"Int J Intell Syst"},{"key":"R42","doi-asserted-by":"crossref","unstructured":"Guo X Yin Y Dong C Yang G Zhou G . On the class imbalance problem. Presented at: 2008 Fourth International Conference on Natural Computation; Oct 18-20, 2008; Jinan, China. URL: https:\/\/ieeexplore.ieee.org\/document\/4667275 [Accessed 01-05-2026]","DOI":"10.1109\/ICNC.2008.871"},{"issue":"1","key":"R43","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset","volume":"10","author":"Johnson","journal-title":"Sci Data"},{"issue":"5","key":"R44","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/MCC.0000000000000535","article-title":"New guidelines for hospital-acquired pneumonia\/ventilator-associated pneumonia: USA vs. Europe","volume":"24","author":"Martin-Loeches","journal-title":"Curr Opin Crit Care"},{"key":"R45","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez A Garc\u00eda S Galar M Prati RC Krawczyk B Herrera F . Learning from Imbalanced Data Sets. Springer; 2018. [doi: 10.1007\/978-3-319-98074-4] ISBN: 9783319980744","DOI":"10.1007\/978-3-319-98074-4"},{"key":"R46","doi-asserted-by":"publisher","DOI":"10.1613\/jair.953","article-title":"SMOTE: synthetic minority over-sampling technique","volume":"16","author":"Chawla","journal-title":"jair"},{"issue":"6","key":"R47","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s00740-014-0027-0","article-title":"Tarragona-strategie: ad\u00e4quate Antibiotikatherapie auf der Intensivstation","volume":"17","author":"Engelmann","journal-title":"Wiener Klinisches Magazin"},{"key":"R48","unstructured":"European Commission. The Digital Economy and Society Index (DESI). 2024. URL: https:\/\/digital-strategy.ec.europa.eu\/en\/policies\/desi [Accessed 24-02-2026]"},{"key":"R49","unstructured":"Bundesministerium f\u00fcr Gesundheit (BMG). Die elektronische Patientenakte (ePA) f\u00fcr alle. 2025. URL: https:\/\/www.bundesgesundheitsministerium.de\/themen\/digitalisierung\/elektronische-patientenakte\/epa-fuer-alle.html [Accessed 20-03-2025]"},{"key":"R50","unstructured":"Gesetz zum verbesserten zugang zu und zur nutzung von daten f\u00fcr die forschung. Deutscher Bundestag. 2025. URL: https:\/\/dip.bundestag.de\/vorgang\/gesetz-zum-verbesserten-zugang-zu-und-zur-nutzung-von-daten\/318777 [Accessed 23-05-2025]"},{"key":"R51","unstructured":"Bundesministerium der Justiz und f\u00fcr Verbraucherschutz. Gesetz zur verbesserten Nutzung von Gesundheitsdaten. 2025. URL: https:\/\/www.recht.bund.de\/bgbl\/1\/2024\/102\/VO.html [Accessed 12-05-2025]"},{"key":"R52","unstructured":"Homepage. NFDI4Health. 2025. URL: https:\/\/www.nfdi4health.de\/ [Accessed 16-10-2025]"},{"key":"R53","unstructured":"The R Project for Statistical Computing. R Foundation for Statistical Computing. 2024. URL: https:\/\/www.R-project.org [Accessed 01-05-2026]"},{"key":"R54","unstructured":"Python language reference, version 3.11.9. Python Software Foundation. 2024. URL: https:\/\/www.python.org [Accessed 01-05-2026]"},{"key":"R55","unstructured":"Fuchslab\/cdss_sepsis. GitHub. URL: https:\/\/github.com\/fuchslab\/CDSS_Sepsis [Accessed 07-05-2026]"}],"container-title":["JMIR Medical Informatics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medinform.jmir.org\/2026\/1\/e79929","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:13:09Z","timestamp":1782843189000},"score":1,"resource":{"primary":{"URL":"https:\/\/medinform.jmir.org\/2026\/1\/e79929"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":55,"URL":"https:\/\/doi.org\/10.2196\/79929","relation":{},"ISSN":["2291-9694"],"issn-type":[{"value":"2291-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"v14i11e79929"}}