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Explainable AI for Infection Prevention and Control: Modeling CPE Acquisition and Patient Outcomes in an Irish Hospital with Transformers

Pham, Minh-Khoi orcid logoORCID: 0000-0003-3211-9076, Mai, Tai Tan orcid logoORCID: 0000-0001-6657-0872, Crane, Martin orcid logoORCID: 0000-0001-7598-3126, Brennan, Rob orcid logoORCID: 0000-0001-8236-362X, Ward, Marie E. orcid logoORCID: 0000-0002-6638-8461, Geary, Una orcid logoORCID: 0000-0001-7052-5863, Byrne, Declan, O'Connell, Brian orcid logoORCID: 0000-0001-6401-6421, Bergin, Colm orcid logoORCID: 0000-0002-6651-1132, Creagh, Donnacha, McDonald, Nick and Bezbradica, Marija orcid logoORCID: 0000-0001-9366-5113 (2025) Explainable AI for Infection Prevention and Control: Modeling CPE Acquisition and Patient Outcomes in an Irish Hospital with Transformers. BMC Medical Informatics and Decision Making, 25 (391). pp. 1-16. ISSN 1472-6947

Abstract
Carbapenemase-Producing Enterobacteriace poses a critical concern for infection prevention and control in hospitals. However, predictive modeling of previously highlighted CPE-associated risks such as readmission, mortality, and extended length of stay (LOS) remains underexplored, particularly with modern deep learning approaches. This study introduces an eXplainable AI modeling framework to investigate CPE impact on patient outcomes from Electronic Medical Records data of an Irish hospital. We analyzed an inpatient dataset from an Irish acute hospital, incorporating diagnostic codes, ward transitions, patient demographics, infection-related variables and contact network features. Several Transformer-based architectures were benchmarked alongside traditional machine learning models. Clinical outcomes were predicted, and XAI techniques were applied to interpret model decisions. Our framework successfully demonstrated the utility of Transformer-based models, with TabTransformer consistently outperforming baselines across multiple clinical prediction tasks, especially for CPE acquisition (AUROC and sensitivity). We found infection-related features, including historical hospital exposure, admission context, and network centrality measures, to be highly influential in predicting patient outcomes and CPE acquisition risk. Explainability analyses revealed that features like "Area of Residence", "Admission Ward" and prior admissions are key risk factors. Network variables like "Ward PageRank" also ranked highly, reflecting the potential value of structural exposure information. This study presents a robust and explainable AI framework for analyzing complex EMR data to identify key risk factors and predict CPE-related outcomes. Our findings underscore the superior performance of the Transformer models and highlight the importance of diverse clinical and network features.
Metadata
Item Type:Article (Published)
Refereed:Yes
Uncontrolled Keywords:Electronic medical records, Deep learning, Explainable AI, Transformers
Subjects:Biological Sciences > Bioinformatics
Humanities > Biological Sciences > Bioinformatics
Computer Science > Artificial intelligence
Computer Science > Machine learning
Medical Sciences > Infection
Physical Sciences > Statistical physics
DCU Faculties and Centres:DCU Faculties and Schools > Faculty of Engineering and Computing
DCU Faculties and Schools > Faculty of Engineering and Computing > School of Computing
Research Institutes and Centres > ADAPT
Publisher:BioMed Central Ltd.
Official URL:https://link.springer.com/article/10.1186/s12911-0...
Copyright Information:Authors
Funders:Taighde Éireann- Research Ireland under Grant Agreement No. 13/RC/2106_P2 at ADAPT, the Research Ireland Centre for AI-Driven Digital Content Technology at DCU funded through the Research Ireland R
ID Code:31739
Deposited On:31 Oct 2025 14:01 by Martin Crane . Last Modified 31 Oct 2025 14:01
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