Episode- and Hospital-Level Modeling of Pan-Resistant Healthcare-Associated Infections (2020-2024) Using...

Background: Pan-drug-resistant (PDR) Acinetobacterinfections are an escalating ICU threat, demanding both patient-level triage and facility-wide forecasting. Objective: The aim of this study was to build a dual-scale AI framework that (i) predicts PDR status at infection onset and (ii) forecasts hospital-level PDR burden through 2027. Methods: We retrospectively analyzed 270 Acinetobacter infection episodes (2020-2024) with 65 predictors spanning demographics, timelines, infection type, resistance-class flags, and a 25-drug antibiogram. TabTransformer and XGBoost were trained on 2020-2023 episodes (n = 210), evaluated by stratified 5-fold CV, and externally tested on 2024 episodes (n = 60). Metrics included AUROC, AUPRC, accuracy, and recall at 90% specificity; AUROC was optimism-corrected via 0.632 + bootstrap and DeLong-tested for drift. SHAP values quantified feature impact. Weekly PDR incidence was forecast with an attention-LSTM model retrained monthly (200 weekly origins, 4-week horizon) and benchmarked against seasonal-naïve, Prophet, and SARIMA models (MAPE and RMSE). Quarterly projections (TFT-lite) extended forecasts to 2027. Results: The CV AUROC was 0.924 (optimism-corrected 0.874); an ensemble of TabTransformer + XGBoost reached 0.958. The 2024 AUROC fell to 0.586 (p < 0.001), coinciding with a PDR prevalence drop (75→38%) and three covariates with PSIs > 1.0. Isotonic recalibration improved the Brier score from 0.326 to 0.207 and yielded a net benefit equivalent to 26 unnecessary isolation-days averted per 100 ICU admissions at a 0.20 threshold. SHAP highlighted Ampicillin/Sulbactam resistance, unknown acquisition mode, and device-related infection as dominant drivers. The attention-LSTM achieved a median weekly MAE of 0.10 (IQR: 0.028-0.985) vs. 1.00 for the seasonal-naïve rule, outperforming it on 48.5% of weeks and surpassing Prophet and SARIMA (MAPE = 6.2%, RMSE = 0.032). TFT-lite projected a ≥ 25% PDR tipping point in 2025 Q1 with a sustained rise in 2027. Conclusions: The proposed framework delivers explainable patient-level PDR risk scores and competitive 4-week and multi-year incidence forecasts despite temporal drift, supporting antimicrobial stewardship and ICU capacity planning. Shrinkage and bootstrap correction were applied to address the small sample size (EPV = 2.1), which poses an overfitting risk. Continuous recalibration and multi-center validation remain priorities.