PT - JOURNAL ARTICLE AU - Gurpreet Dhanda AU - Mirna Asham AU - Denton Shanks AU - Nicole O’Malley AU - Joel Hake AU - Megha Teeka Satyan AU - Nicole T. Yedlinsky AU - Daniel J. Parente TI - Adaptation and External Validation of Pathogenic Urine Culture Prediction in Primary Care Using Machine Learning AID - 10.1370/afm.2902 DP - 2023 Jan 01 TA - The Annals of Family Medicine PG - 11--18 VI - 21 IP - 1 4099 - http://www.annfammed.org/content/21/1/11.short 4100 - http://www.annfammed.org/content/21/1/11.full SO - Ann Fam Med2023 Jan 01; 21 AB - BACKGROUND Urinary tract infection (UTI) symptoms are common in primary care, but antibiotics are appropriate only when an infection is present. Urine culture is the reference standard test for infection, but results take >1 day. A machine learning predictor of urine cultures showed high accuracy for an emergency department (ED) population but required urine microscopy features that are not routinely available in primary care (the NeedMicro classifier).METHODS We redesigned a classifier (NoMicro) that does not depend on urine microscopy and retrospectively validated it internally (ED data set) and externally (on a newly curated primary care [PC] data set) using a multicenter approach including 80,387 (ED) and 472 (PC) adults. We constructed machine learning models using extreme gradient boosting (XGBoost), artificial neural networks, and random forests (RFs). The primary outcome was pathogenic urine culture growing ≥100,000 colony forming units. Predictor variables included age; gender; dipstick urinalysis nitrites, leukocytes, clarity, glucose, protein, and blood; dysuria; abdominal pain; and history of UTI.RESULTS Removal of microscopy features did not severely compromise performance under internal validation: NoMicro/XGBoost receiver operating characteristic area under the curve (ROC-AUC) 0.86 (95% CI, 0.86-0.87) vs NeedMicro 0.88 (95% CI, 0.87-0.88). Excellent performance in external (PC) validation was also observed: NoMicro/RF ROC-AUC 0.85 (95% CI, 0.81-0.89). Retrospective simulation suggested that NoMicro/RF can be used to safely withhold antibiotics for low-risk patients, thereby avoiding antibiotic overuse.CONCLUSIONS The NoMicro classifier appears appropriate for PC. Prospective trials to adjudicate the balance of benefits and harms of using the NoMicro classifier are appropriate.