Abstract Long diagnostic wait times hinder international efforts to address multi-drug resistance in M. tuberculosis . Pathogen whole genome sequencing, coupled with statistical and machine learning models, offers a promising solution. However, generalizability and clinical adoption have been limited in part by a lack of interpretability and verifiability, especially in deep learning methods. Here, we present a deep convolutional neural network (CNN) that predicts the antibiotic resistance phenotypes of M. tuberculosis isolates. The CNN performs with state-of-the-art levels of predictive accuracy. Evaluation of salient sequence features permits biologically meaningful interpretation and validation of the CNN’s predictions, with promising repercussions for functional variant discovery, clinical applicability, and translation to phenotype prediction in other organisms.

A convolutional neural network highlights mutations relevant to antimicrobial resistance in Mycobacterium tuberculosis