Personalized AI Model for Antibiotics Prescribing

Antibiotics are widely used for treating patients with infectious diseases or preventing some types of bacterial infections. To ensure the effectiveness of antibiotic therapy, susceptibility tests are used to support antibiotic selection. However, antibiotic susceptibility tests routinely take 2 days to turn around and only when bacterial infection can be confirmed (~50%). As there is also limited understanding of an individual's risk factors for resistance, this substantially delays appropriate therapy, drives pressures on antimicrobial resistance through the empiric use of broad-spectrum antibiotics, and increases unnecessary costs for patients. Additionally, many risks associated with the use of antibiotics need to be carefully considered, such as adverse side effects, complications, the development of antibiotic resistance, and negative interactions with other medications patients are taking. This project aims at developing a personalized machine-learning-based model with the exposition of uncertainty to guide antibiotics prescription, based on a huge, linked dataset of primary and secondary care records, the systemwide HDR-UK dataset. Focusing on clinical decision support, we will train an antibiotic resistance prediction model and investigate what modifiable risk factors predict antibiotic resistance and why, how the resistance changes along with time, whether other medications affect the effectiveness of antibiotics and how, to inform health services and policy research. Based on the model and answers to these questions, we will enable prescribing algorithms that give individualized antibiotic prescription recommendations for patients. Finally, the model and algorithms will be carefully assessed, doctors view about recommendations made by such systems will be investigated, and an antimicrobial stewardship dashboard will be co-designed with clinicians.

Impact on Health and Care
The CDT primarily addresses the most pressing needs of nations such as the UK - namely the growth of expenditure on long term health conditions. These conditions (e.g. diabetes, depression, arthritis) cost the NHS over £70Bn a year (~70% of its budget). As our populations continue to age these illnesses threaten the nation's health and its finances.

Digital technologies transforming our world - from transport to relationships, from entertainment to finance - and there is consensus that digital solutions will have a huge role to play in health and care. Through the CDT's emphasis on multidisciplinarity, teamwork, design and responsible innovation, it will produce future leaders positioned to seize that opportunity.

Impact on the Economy
The UK has Europe's 2nd largest medical technology industry and a hugely strong track record in health, technology and societal research. It is very well-placed to develop digital health and care solutions that meet the needs of society through the creation of new businesses.

Achieving economic impact is more than a matter of technology. The CDT has therefore been designed to ensure that its graduates are team players with deep understanding of health and social care systems, good design and the social context within which a new technology is introduced.

Many multinationals have been keen to engage the CDT (e.g. Microsoft, AstraZeneca, Lilly, Biogen, Arm, Huawei ) and part of the Director's role will be to position the UK as a destination for inwards investment in Digital Health. CDT partners collectively employ nearly 1,000,000 people worldwide and are easily in a position to create thousands of jobs in the UK.

The connection to CDT research will strongly benefit UK enterprises such as System C and Babylon, along with smaller companies such as Ayuda Heuristics and Evolyst.

Impact on the Public
When new technologies are proposed to collect and analyse highly personal health data, and are potentially involved in life or death decisions, it is vital that the public are given a voice. The team's experience is that listening to the public makes research better, however involving a full spectrum of the community in research also has benefits to those communities; it can be empowering, it can support the personal development of individuals within communities who may have little awareness of higher education and it can catalyse community groups to come together around key health and care issues.

Policy Makers
From the team's conversations with the senior leadership of the NHS, local leaders of health and social care transformation (see letters from NHS and Bristol City Council) and national reports, it is very apparent that digital solutions are seen as vital to the delivery of health and care. The research of the CDT can inform policy makers about the likely impact of new technology on future services.

Partner organisation Care & Repair will disseminate research findings around independent living and have a track record of translating academic research into changes in practice and policy.

Carers UK represent the role of informal carers, such as family members, in health and social care. They have a strong voice in policy development in the UK and are well-placed to disseminate the CDTs research to policy makers.

STEM Education
It has been shown that outreach for school age children around STEM topics can improve engagement in STEM topics at school. However female entry into STEM at University level remains dramatically lower than males; the reverse being true for health and life sciences. The CDT outreach leverages this fact to focus STEM outreach activities on digital health and care, which can encourage young women into computer science and impact on the next generation of women in higher education.

For academic impact see "Academic Beneficiaries" section.