Identifying the Optimal Look-back Period for Prior Antimicrobial Resistance Clinical Decision Support

Background: Lack of consensus on the appropriate look-back period for multi-drug resistance (MDR) complicates antimicrobial clinical decision support. We compared the predictive performance of different MDR look-back periods for five common MDR mechanisms (MRSA, VRE, ESBL, AmpC, CRE).

Methods: We mapped microbiological cultures to MDR mechanisms and labeled them at different look-back periods. We compared predictive performance for each look-back period-MDR combination using precision, recall, F1 scores, and odds ratios.

Results: Longer look-back periods resulted in lower odds ratios, lower precisions, higher recalls, and lower delta changes in precision and recall compared to shorter periods. We observed higher precision with more information available to clinicians.

Conclusion: A previously positive MDR culture may have significant enough precision depending on the mechanism of resistance and varying information available. One year is a clinically relevant and statistically sound look-back period for empiric antimicrobial decision-making at varying points of care for the studied population.