Developing and validating a machine learning model to predict multidrug-resistant

Background: Multidrug-resistant Klebsiella pneumoniae (MDR-KP) infections pose a significant global healthcare challenge, particularly due to the high mortality risk associated with septic shock. This study aimed to develop and validate a machine learning-based model to predict the risk of MDR-KP-associated septic shock, enabling early risk stratification and targeted interventions. Methods: A retrospective analysis was conducted on 1,385 patients with MDR-KP infections admitted between January 2019 and June 2024. The cohort was randomly divided into a training set (n = 969) and a validation set (n = 416). Feature selection was performed using LASSO regression and the Boruta algorithm. Seven machine learning algorithms were evaluated, with logistic regression chosen for its optimal balance between performance and robustness against overfitting. Results: The overall incidence of MDR-KP-associated septic shock was 16.32% (226/1,385). The predictive model identified seven key risk factors: procalcitonin (PCT), sepsis, acute kidney injury, intra-abdominal infection, use of vasoactive medications, ventilator weaning failure, and mechanical ventilation. The logistic regression model demonstrated excellent predictive performance, with an area under the receiver operating characteristic curve (AUC) of 0.906 in the training set and 0.865 in the validation set. Calibration was robust, with Hosmer-Lemeshow test results of Conclusion: This study presents a validated, high-performing predictive model for MDR-KP-associated septic shock, offering a valuable tool for early clinical decision-making. Prospective, multi-center studies are recommended to further evaluate its clinical applicability and effectiveness in diverse settings.