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Machine Learning for Pre-Culture ESBL Risk Stratification to Guide Empiric Antibiotic Selection: A 12-Hospital Study of Enterobacteriaceae Cultures

arXiv · AI, language, vision and robotics · article · Sep 5, 2026 · UTC

Empiric antibiotic therapy for suspected ESBL-producing Enterobacteriaceae must be selected 48-72 hours before culture results, forcing clinicians to choose between undertreating resistant infections and overusing carbapenems that drive further resistance. We developed a cost-sensitive XGBoost model predicting an ESBL phenotype (resistance to ceftriaxone, ceftazidime, cefepime or piperacillin-tazobactam) at culture ordering using 45 pre-culture EHR features across 132,955 cultures from 72,217 patients at 12 hospitals (14.41% with the ESBL phenotype). Cultures were partitioned at the patient le

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