Harnessing Machine Learning for Antimicrobial Resistance Surveillance in Zimbabwe

Antimicrobial resistance (AMR) poses a significant public health challenge, particularly in resource-limited settings such as Zimbabwe, where surveillance systems are often underdeveloped. This study aims to characterise AMR patterns at the Gweru Provincial Hospital (GPH) and evaluate machine learning (ML) models for predicting resistance to enhance surveillance. This retrospective cross-sectional study included 4 054 clinical isolates from 874 patients (2022–2024). Five ML models, namely, support vector machine (SVM), random forest, logistic regression, gradient boosting, and k-nearest neighbors (KNN), were trained and evaluated, with a focus on predictive performance for surveillance purposes. Among all the evaluated models, the SVM achieved the highest accuracy (72.08%), precision (73.25%), recall (79.78%), F1 score (0.76), and AUC-ROC (0.79), indicating that it was the most effective model for AMR surveillance in this study. Feature importance analysis revealed that antibiotic class, hospital ward, patient age, and pathogen type were significant predictors of resistance. Notably, resistance was high for tetracycline (72.1%) and nitrofurantoin (75.7%), whereas imipenem (7.7%) presented the lowest resistance rates. Multidrug resistance was high among S. aureus (30%), whereas Shigella spp. and Serratia marcescens showed no multidrug resistance. This study highlights the significant AMR burden in Gweru and demonstrates the potential of ML, particularly SVM, for use in predictive surveillance. These findings support targeted interventions in high-risk hospital wards against specific pathogens, offering a scalable approach to AMR monitoring in resource-limited settings.