Predicting Multidrug-Resistant Infection upon Admission to Hospitals: A Prospective Interventional Multicenter Crossover Trial

Delayed initiation of appropriate antimicrobial therapy (DAAT) is the strongest modifiable independent predictor of mortality in severe sepsis and occurs frequently in patients with multidrug-resistant organism infections upon hospital admission (MDR-UA). This study evaluated whether a bedside MDR-UA prediction calculator reduces DAAT and improves clinical outcomes. A prospective interventional crossover trial was conducted (July 2023–September 2024) across two large academic hospitals in central Israel. Adult inpatients with sepsis were enrolled; during intervention periods, the calculator score was communicated to Infectious Diseases consultants within 48 hours. DAAT and hospitalization outcomes were compared by using multivariable regressions. Of 1,524 enrolled patients, 514 (33%) had microbiologically confirmed infection, of whom 200 (39%) had MDR-UA. The calculator demonstrated suboptimal performances (ROC-AUC: 0.68), and the intervention had no impact on DAAT ( p = 0.50). The intervention was independently associated with reduced discharge rates to long-term care facilities among survivors of the index stay who were admitted from home (aOR = 2.0; 95% CI: 1.3–3.2), but did not affect mortality or other hospitalization’s outcomes. This prospective trial demonstrates that an MDR-UA calculator exhibiting lower-than-expected predictive performance did not reduce DAAT in routine clinical practice, highlighting the importance of prospective validation of clinical prediction tools. AI-based adaptive platforms may offer an alternative to current static prediction models.