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Health care–associated infections due to multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (CDI), place a significant burden on our health care infrastructure. Screening for MDROs is an important mechanism for preventing spread but is resource intensive. The objective of this study was to develop automated tools that can predict colonization or infection risk using electronic health record (EHR) data, provide useful information to aid infection control, and guide empiric antibiotic coverage. We retrospectively developed a machine learning model to detect MRSA colonization and infection in undifferentiated patients at the time of sample collection from hospitalized patients at the University of Virginia Hospital. We used clinical and nonclinical features derived from on-admission and throughout-stay information from the patient’s EHR data to build the model. In addition, we used a class of features derived from contact networks in EHR data; these network features can capture patients’ contacts with providers and other patients, improving model interpretability and accuracy for predicting the outcome of surveillance tests for MRSA. Finally, we explored heterogeneous models for different patient subpopulations, for example, those admitted to an intensive care unit or emergency department or those with specific testing histories, which perform better. We found that the penalized logistic regression performs better than other methods, and this model’s performance measured in terms of its receiver operating characteristics-area under the curve score improves by nearly 11% when we use polynomial (second-degree) transformation of the features. Some significant features in predicting MDRO risk include antibiotic use, surgery, use of devices, dialysis, patient’s comorbidity conditions, and network features. Among these, network features add the most value and improve the model’s performance by at least 15%. The penalized logistic regression model with the same transformation of features also performs better than other models for specific patient subpopulations. Our study shows that MRSA risk prediction can be conducted quite effectively by machine learning methods using clinical and nonclinical features derived from EHR data. Network features are the most predictive and provide significant improvement over prior methods. Furthermore, heterogeneous prediction models for different patient subpopulations enhance the model’s performance. 

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria resistant to certain antibiotics, making it difficult to prevent MRSA infections. Among decades of efforts to conquer infectious diseases caused by MRSA, many studies have been proposed to estimate the causal effects of close contact (treatment) on MRSA infection (outcome) from observational data. In this problem, the treatment assignment mechanism plays a key role as it determines the patterns of missing counterfactuals --- the fundamental challenge of causal effect estimation. Most existing observational studies for causal effect learning assume that the treatment is assigned individually for each unit. However, on many occasions, the treatments are pairwisely assigned for units that are connected in graphs, i.e., the treatments of different units are entangled. Neglecting the entangled treatments can impede the causal effect estimation. In this paper, we study the problem of causal effect estimation with treatment entangled in a graph. Despite a few explorations for entangled treatments, this problem still remains challenging due to the following challenges: (1) the entanglement brings difficulties in modeling and leveraging the unknown treatment assignment mechanism; (2) there may exist hidden confounders which lead to confounding biases in causal effect estimation; (3) the observational data is often time-varying. To tackle these challenges, we propose a novel method NEAT, which explicitly leverages the graph structure to model the treatment assignment mechanism, and mitigates confounding biases based on the treatment assignment modeling. We also extend our method into a dynamic setting to handle time-varying observational data. Experiments on both synthetic datasets and a real-world MRSA dataset validate the effectiveness of the proposed method, and provide insights for future applications.