Artificial intelligence in antimicrobial stewardship: a systematic review and meta-analysis of predictive performance and diagnostic accuracy

The increasing threat of antimicrobial resistance has prompted a need for more effective antimicrobial stewardship programs (AMS). Artificial intelligence (AI) and machine learning (ML) tools have emerged as potential solutions to enhance decision-making and improve patient outcomes in AMS. This systematic review and meta-analysis aims to evaluate the impact of AI in AMS and to assess its predictive performance and diagnostic accuracy. We conducted a comprehensive literature search across PubMed/MEDLINE, Scopus, EMBASE, and Web of Science to identify studies published up to July 2024. Studies included were observational, cohort, or retrospective, focusing on the application of AI/ML in AMS. The outcomes assessed were the area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We calculated the mean pooled effect size (ES) and its 95% confidence interval (CI) using a random-effects model. The risk of bias was assessed using the QUADAS-AI tool, and the protocol was registered in PROSPERO. Out of 3,458 retrieved articles, 80 studies met the inclusion criteria. Our meta-analysis demonstrated that ML models exhibited strong predictive performance and diagnostic accuracy, with the following results: AUC [ES: 72.28 (70.42-74.14)], accuracy [ES: 74.97 (73.35-76.58)], sensitivity [ES: 76.89; (71.90-81.89)], specificity [ES: 73.77; (67.87-79.67)], NPV [ES:79.92 (76.54-83.31)], and PPV [ES: 69.41 (60.19-78.63)] across various AMS settings. AI and ML tools offer promising enhancements due to their strong predictive performance. The integration of AI into AMS could lead to more precise antimicrobial prescribing, reduced antimicrobial resistance, and better resource utilization.