Evaluation of Marker Gene-Based In Silico Antimicrobial Resistance Prediction Tools

The monitoring and surveillance of antimicrobial resistance (AMR) is an important procedure in clinical patient management and epidemiological public health. Conventionally, culture-based tools such as disk diffusion methods or broth dilution methods for antibiotic susceptibility tests are used. While culture-independent approaches, such as PICRUSt2, Tax4Fun, or MicFunPred, have recently been tried based on predictive functional profiling using the 16S rRNA marker gene, evaluations of AMR tools are scarce. A total of 20 <i>E. coli</i> strains (Carbapenem-resistant (CRE) positive: 10, CRE negative: 10) were used. The AMR phenotype was based on Vitek2 (bioMerieux). DNA was extracted from the 20 strains, and 16S rRNA (V3-V4 region) and shotgun sequencing was carried out. The bioinformatic pipelines were QIIM2 for 16S rRNA and MetaPhlAn4 for shotgun. The functional prediction tools were PICRUSt2, Tax4Fun, and MicFunPred for 16S rRNA and AMRFinderPlus for shotgun. The presence/absence of 23 KEGG numbers regarding AMR in PICRUSt2, Tax4Fun, and MicFunPred were compared to shotgun AMR profiles. The F1 scores were calculated according to each 16S marker gene-based prediction tool using a confusion matrix. A total of 12 classes of antibiotics, including carbapenem, were analyzed. The F1 scores of 16S predictive functional profilers regarding AMR were 0.22 for Tax4Fun, 0.12 for PICRUSt2, and 0.08 for MicFunPred. While Tax4Fun showed the highest F1 score of the three 16S predictive functional profilers, the F1 scores were generally low. Our study highlights the necessity of integrating specialized AMR databases and improving algorithmic approaches to achieve meaningful accuracy in resistance prediction.