| Autor: |
Hur R; Department of Inpatient Pharmacy, Kaiser Permanente, One Kaiser Plaza, Oakland, CA 94612, USA.; Haas School of Business, University of California, Berkeley, CA 94720, USA.; School of Pharmacy, University of California, San Francisco, CA 94143, USA., Golik S; Department of Inpatient Pharmacy, Kaiser Permanente, One Kaiser Plaza, Oakland, CA 94612, USA.; Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA., She Y; Department of Inpatient Pharmacy, Kaiser Permanente, One Kaiser Plaza, Oakland, CA 94612, USA.; School of Pharmacy, University of California, San Francisco, CA 94143, USA. |
| Abstrakt: |
Drug-resistant Gram-negative bacterial infections, on average, increase the length of stay (LOS) in U.S. hospitals by 5 days, translating to approximately $15,000 per patient. We used statistical and machine-learning models to explore the relationship between antibiotic usage and antibiotic resistance over time and to predict the clinical and financial costs associated with resistant E. coli infections. We acquired data on antibiotic utilization and the resistance/sensitivity of 4776 microbial cultures at a Kaiser Permanente facility from April 2013 to December 2019. The ARIMA (autoregressive integrated moving average), neural networks, and random forest time series algorithms were employed to model antibiotic resistance trends. The models' performance was evaluated using mean absolute error (MAE) and root mean squared error (RMSE). The best performing model was then used to predict antibiotic resistance rates for the year 2020. The ARIMA model with cefazolin, followed by the one with cephalexin, provided the lowest RMSE and MAE values without signs of overfitting across training and test datasets. The study showed that reducing cefazolin usage could decrease the rate of resistant E. coli infections. Although piperacillin/tazobactam did not perform as well as cefazolin in our time series models, it performed reasonably well and, due to its broad spectrum, might be a practical target for interventions in antimicrobial stewardship programs (ASPs), at least for this particular facility. While a more generalized model could be developed with data from multiple facilities, this study acts as a framework for ASP clinicians to adopt statistical and machine-learning approaches, using region-specific data to make effective interventions. |
