Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models

Abstract Background Bloodstream infection (BSI) is a systemic infection that predisposes individuals to sepsis and multiple organ dysfunction syndrome. Early identification of infectious agents and determination of drug-resistant phenotypes can help patients with BSI receive timely, effective, and t...

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Main Authors: Xiaobo Xu, Zhaofeng Wang, Erjie Lu, Tao Lin, Hengchao Du, Zhongfei Li, Jiahong Ma
Format: Article
Language:English
Published: BMC 2025-01-01
Series:BMC Microbiology
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Online Access:https://doi.org/10.1186/s12866-025-03755-5
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author Xiaobo Xu
Zhaofeng Wang
Erjie Lu
Tao Lin
Hengchao Du
Zhongfei Li
Jiahong Ma
author_facet Xiaobo Xu
Zhaofeng Wang
Erjie Lu
Tao Lin
Hengchao Du
Zhongfei Li
Jiahong Ma
author_sort Xiaobo Xu
collection DOAJ
description Abstract Background Bloodstream infection (BSI) is a systemic infection that predisposes individuals to sepsis and multiple organ dysfunction syndrome. Early identification of infectious agents and determination of drug-resistant phenotypes can help patients with BSI receive timely, effective, and targeted treatment and improve their survival. This study was based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), Decision Tree (DT), Random Forest (RF), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), and Extremely Randomized Trees (ERT) models were constructed to classify carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP). Bacterial species were identified by MALDI-TOF MS in positive blood cultures isolated via the serum isolation gel method, and E. coli and K. pneumoniae in positive blood cultures were collected and placed into machine learning models to predict susceptibility to carbapenems. The aim of this study was to provide rapid detection of CREC and CRKP in blood cultures, to shorten the turnaround time for laboratory reporting, and to provide a basis for early clinical intervention and rational use of antibiotics. Results The collected MALDI-TOF MS data of 640 E. coli and 444 K. pneumoniae were analysed by machine learning algorithms. The area under the receiver operating characteristic curve (AUROC) for the diagnosis of E. coli susceptibility to carbapenems by the DT, RF, GBM, XGBoost, and ERT models were 0.95, 1.00, 0.99, 0.99, and 1.00, respectively, and the accuracy in predicting 149 E. coli-positive blood cultures were 0.89, 0.92, 0.90, 0.92, and 0.86, respectively. The AUROC for the diagnosis of K. pneumoniae susceptibility to carbapenems by the DT, RF, GBM, XGBoost, and ERT models were 0.78, 0.95, 0.93, 0.90, and 0.95, respectively, and the accuracy in predicting 127 K. pneumoniae-positive blood cultures were 0.76, 0.86, 0.81, 0.80, and 0.76, respectively. Conclusions Machine learning models constructed by MALDI-TOF MS were able to directly predict the susceptibility of E. coli and K. pneumoniae in positive blood cultures to carbapenems. This rapid identification of CREC and CRKP reduces detection time and contributes to early warning and response to potential antibiotic resistance problems in the clinic. Clinical trial number Not applicable.
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spelling doaj-art-14879f6bff804cfa891f94628555dd6d2025-01-26T12:17:54ZengBMCBMC Microbiology1471-21802025-01-012511810.1186/s12866-025-03755-5Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning modelsXiaobo Xu0Zhaofeng Wang1Erjie Lu2Tao Lin3Hengchao Du4Zhongfei Li5Jiahong Ma6Department of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalDepartment of Clinical Laboratory, Zhejiang Rong Jun HospitalAbstract Background Bloodstream infection (BSI) is a systemic infection that predisposes individuals to sepsis and multiple organ dysfunction syndrome. Early identification of infectious agents and determination of drug-resistant phenotypes can help patients with BSI receive timely, effective, and targeted treatment and improve their survival. This study was based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), Decision Tree (DT), Random Forest (RF), Gradient Boosting Machine (GBM), eXtreme Gradient Boosting (XGBoost), and Extremely Randomized Trees (ERT) models were constructed to classify carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP). Bacterial species were identified by MALDI-TOF MS in positive blood cultures isolated via the serum isolation gel method, and E. coli and K. pneumoniae in positive blood cultures were collected and placed into machine learning models to predict susceptibility to carbapenems. The aim of this study was to provide rapid detection of CREC and CRKP in blood cultures, to shorten the turnaround time for laboratory reporting, and to provide a basis for early clinical intervention and rational use of antibiotics. Results The collected MALDI-TOF MS data of 640 E. coli and 444 K. pneumoniae were analysed by machine learning algorithms. The area under the receiver operating characteristic curve (AUROC) for the diagnosis of E. coli susceptibility to carbapenems by the DT, RF, GBM, XGBoost, and ERT models were 0.95, 1.00, 0.99, 0.99, and 1.00, respectively, and the accuracy in predicting 149 E. coli-positive blood cultures were 0.89, 0.92, 0.90, 0.92, and 0.86, respectively. The AUROC for the diagnosis of K. pneumoniae susceptibility to carbapenems by the DT, RF, GBM, XGBoost, and ERT models were 0.78, 0.95, 0.93, 0.90, and 0.95, respectively, and the accuracy in predicting 127 K. pneumoniae-positive blood cultures were 0.76, 0.86, 0.81, 0.80, and 0.76, respectively. Conclusions Machine learning models constructed by MALDI-TOF MS were able to directly predict the susceptibility of E. coli and K. pneumoniae in positive blood cultures to carbapenems. This rapid identification of CREC and CRKP reduces detection time and contributes to early warning and response to potential antibiotic resistance problems in the clinic. Clinical trial number Not applicable.https://doi.org/10.1186/s12866-025-03755-5Blood culturesMALDI-TOF MSMachine learningEscherichia coliKlebsiella pneumoniae
spellingShingle Xiaobo Xu
Zhaofeng Wang
Erjie Lu
Tao Lin
Hengchao Du
Zhongfei Li
Jiahong Ma
Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
BMC Microbiology
Blood cultures
MALDI-TOF MS
Machine learning
Escherichia coli
Klebsiella pneumoniae
title Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
title_full Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
title_fullStr Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
title_full_unstemmed Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
title_short Rapid detection of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae in positive blood cultures via MALDI-TOF MS and tree-based machine learning models
title_sort rapid detection of carbapenem resistant escherichia coli and carbapenem resistant klebsiella pneumoniae in positive blood cultures via maldi tof ms and tree based machine learning models
topic Blood cultures
MALDI-TOF MS
Machine learning
Escherichia coli
Klebsiella pneumoniae
url https://doi.org/10.1186/s12866-025-03755-5
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