International Journal of Science, Engineering and TechnologyAuthors: Seshu Kumari K, Dr. Munesh Kumar Sharma
Abstract: Frameworks that convert resistome content into antimicrobial guidance must decide what to do when no resistance determinant is found. The decision is easy to get wrong, and the error is invisible at the scale at which such frameworks are usually run. This paper audits, decision by decision, the 96 class-level outputs of a six-stage resistome-to-guidance framework applied to ten reference strains of the human gut microbiota carrying six determinants, against standard clinical microbiological references. Under a binary rule in which a determinant count of zero produces the decision preferred candidate, 89 of 96 decisions were positive recommendations. Eight classes of error were identified, several contradicting firmly established fact: cephalosporins were recommended for Enterococcus faecalis V583, which is intrinsically resistant to the entire class through low-affinity penicillin-binding proteins; aminoglycosides were recommended for both Bacteroides strains, which cannot accumulate the drug for want of oxygen-dependent uptake; and penicillins were recommended for both Enterobacterales despite a curated β-lactamase mapping to the penam ontology class, an implementation defect distinct from the conceptual one. Twelve of the sixteen clinical classes were unrepresented in the determinant panel and returned zero for every strain. A revised three-state rule, supplemented by a separately compiled intrinsic resistance register, removes every identified error; it converts 89 positive recommendations into 23 avoidance decisions on register evidence and 66 explicit statements of absence of evidence, and emits no positive recommendation at all. We argue that this last property is a requirement rather than a deficiency of any determinant-based guidance system, and that small auditable panels are a necessary stage in the validation of such systems.
DOI: https://zenodo.org/records/22977211
