ReShuffle-MS: Region-Guided Data Augmentation Improves Artificial Intelligence-Based Resistance Prediction in Escherichia coli from MALDI-TOF Mass Spectrometry

Rapid antimicrobial resistance (AMR) prediction from MALDI-TOF mass spectrometry (MS) remains challenging, particularly when training artificial intelligence (AI) models under small-sample constraints. Performance is often hampered by the high dimensionality of spectral data and the subtle nature of resistance-related signals: full-spectrum approaches risk overfitting to high-dimensional noise, whereas peak-selection strategies risk discarding structurally informative, low-intensity signals. Here, we propose ReShuffle-MS, a region-guided data augmentation framework for MS data. Each spectrum is partitioned into a Main Discriminative Region (MDR) and a Peripheral Peak Region (PPR). By recombining signals within the PPR across samples of the same class while keeping the MDR intact, ReShuffle-MS generates structure-preserving augmented samples. On a clinical dataset for <i>Escherichia coli</i> (<i>E. coli</i>) levofloxacin resistance prediction, ReShuffle-MS delivered significant and consistent performance gains. It improved the average accuracy of classical machine learning models by 3.7% and enabled a one-dimensional convolutional neural network (CNN) to achieve 83.25% accuracy and 97.28% recall. Visualization using Grad-CAM revealed a shift from sparse, peak-dependent attention toward broader and more meaningful spectral patterns. Validation on the external DRIAMS-C dataset for ceftriaxone resistance further demonstrated that the method generalizes to a distinct laboratory setting and a different antibiotic target. These findings suggest that ReShuffle-MS can enhance the robustness and clinical utility of AI-based AMR prediction from routinely acquired MALDI-TOF spectra.