Exploring the evolution of multidrug resistance patterns in ESKAPEE pathogens using association mining: Key to...

Shared Multidrug resistance (sMDR) is a major challenge in antimicrobial therapy, particularly among ESKAPEE pathogens, as these bacteria develop resistance to multiple antimicrobial agents via mutations, recombination, or gene transfer. These antimicrobial resistance (AMR) mechanisms evolve and require constant surveillance. Understanding sMDR patterns in large antimicrobial surveillance datasets is complex because of the multifaceted nature of the data.

We explored Pfizer-Atlas (2004 - 2022) and Venatorx-GEARS (2018-2022) datasets from the Vivli platform, focusing on ESKAPEE pathogens. Descriptive data analysis, time-trend analysis, and association rule generation through the Apriori algorithm were performed using Python 3.10 libraries pandas, matplotlib, seaborn, scipy.stats, and mlxtend libraries. The best rule set that explored sMDR patterns was visualized in a network format using NetworkX: 3.2 package.

"MERIT- Multidrug ESKAPEE Resistance Insights and Tracker" dashboard was created for user-friendly visualization of antimicrobial surveillance datasets, trends in antimicrobial susceptibility profile (ASP) over years, interactive widgets to see the ASP by country and by pathogens, and Network to see significant rules as a result of association rule mining in categories by age, year and country.

Time trend analysis revealed a decline in meropenem and piperacillin-tazobactam resistance to Enterococcus faecium and doripenem for Pseudomonas aeruginosa, while resistance to imipenem ( Klebsiella pneumoniae, Acinetobacter baumannii, and Enterobacter species) and meropenem ( Staphylococcus aureus, A. baumannii, and Enterobacter species) increased. Association rule mining identified sMDR patterns, such as meropenem and levofloxacin resistance, in S. aureus, K. pneumoniae, P. aeruginosa and A. baumannii. Thus, our findings from the data challenge represents hypothesis driven patterns intended to promote further investigation and clinical validation which potentially supports antibiotic stewardship efforts.