A risk assessment framework for multidrug-resistant Staphylococcus aureus using machine learning and mass spectrometry technology

Zhuo Wang, Yuxuan Pang, Chia Ru Chung, Hsin Yao Wang, Haiyan Cui, Ying Chih Chiang, Jorng Tzong Horng, Jang Jih Lu, Tzong Yi Lee

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The emergence of multidrug-resistant bacteria is a critical global crisis that poses a serious threat to public health, particularly with the rise of multidrug-resistant Staphylococcus aureus. Accurate assessment of drug resistance is essential for appropriate treatment and prevention of transmission of these deadly pathogens. Early detection of drug resistance in patients is critical for providing timely treatment and reducing the spread of multidrug-resistant bacteria. This study aims to develop a novel risk assessment framework for S. aureus that can accurately determine the resistance to multiple antibiotics. The comprehensive 7-year study involved >20 000 isolates with susceptibility testing profiles of six antibiotics. By incorporating mass spectrometry and machine learning, the study was able to predict the susceptibility to four different antibiotics with high accuracy. To validate the accuracy of our models, we externally tested on an independent cohort and achieved impressive results with an area under the receiver operating characteristic curve of 0. 94, 0.90, 0.86 and 0.91, and an area under the precision–recall curve of 0.93, 0.87, 0.87 and 0.81, respectively, for oxacillin, clindamycin, erythromycin and trimethoprim-sulfamethoxazole. In addition, the framework evaluated the level of multidrug resistance of the isolates by using the predicted drug resistance probabilities, interpreting them in the context of a multidrug resistance risk score and analyzing the performance contribution of different sample groups. The results of this study provide an efficient method for early antibiotic decision-making and a better understanding of the multidrug resistance risk of S. aureus.

Original languageEnglish
Article numberbbad330
JournalBriefings in bioinformatics
Issue number6
StatePublished - 1 Nov 2023


  • machine learning
  • matrix-associated laser desorption and ionization/time-of-flight mass spectrometry
  • methicillin-resistant Staphylococcus aureus
  • risk assessment of multidrug-resistant bacteria


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