Background: Desirability of outcome ranking (DOOR) is an emerging approach to clinical trial outcome measurement using an ordinal scale to incorporate efficacy and safety endpoints.

Methods: We applied a previously validated DOOR endpoint to a cohort of CAMERA2 trial participants with methicillin-resistant bacteremia (MRSAB). Participants were randomly assigned to standard therapy, or to standard therapy plus an antistaphylococcal β-lactam (combination therapy). Each participant was assigned a DOOR category, within which they were further ranked according to their hospital length of stay (LOS) and duration of intravenous antibiotic treatment. We calculated the probability and the generalized odds ratio of participants receiving combination therapy having worse outcomes than those receiving standard therapy.

Results: Participants assigned combination therapy had a 54.5% (95% confidence interval [CI], 48.9%-60.1%; = .11) probability and a 1.2-fold odds (95% CI, .95-1.50; = .12) of having a worse outcome than participants on standard therapy. When further ranked according to LOS and duration of antibiotic treatment, participants in the combination group had a 55.6% (95% CI, 49.5%-61.7%) and 55.3% (95% CI, 49.2%-61.4%) probability of having a worse outcome than participants in the standard treatment group, respectively.

Conclusions: When considering both efficacy and safety, treatment of MRSAB with a combination of standard therapy and a β-lactam likely results in a worse clinical outcome than standard therapy. However, a small benefit of combination therapy cannot be excluded. Most likely the toxicity of combination therapy outweighed any benefit from faster clearance of bacteremia.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11065345PMC
http://dx.doi.org/10.1093/ofid/ofae181DOI Listing

Publication Analysis

Top Keywords

standard therapy
28
combination therapy
20
therapy
12
standard
9
combination
8
antistaphylococcal β-lactam
8
methicillin-resistant bacteremia
8
camera2 trial
8
desirability outcome
8
outcome ranking
8

Similar Publications

Aim: The purpose of this study is to compare the efficacy of an artificial intelligence (AI)-based care plan learning strategy with standard training techniques in order to determine how it affects nursing students' learning results in newborn resuscitation.

Methods: Seventy third-year nursing students from a state university in Türkiye participated in the study. They were split into two groups: the experimental group, which received care plans based on AI, and the control group, which received traditional instruction.

View Article and Find Full Text PDF

Introduction: Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease. According to the European League Against Rheumatism (EULAR), the stages of RA progression include pre-RA, preclinical RA, inflammatory arthralgia, arthralgia with positive antibodies, arthralgia suspected of progressing to RA, undifferentiated arthritis and finally established RA. According to the Community Oriented Program for Control of Rheumatic Diseases (COPCORD), the prevalence of RA in Mexico is 1.

View Article and Find Full Text PDF

Objective measures of oral PrEP adherence - especially point-of-care (POC) measures that enable real-time assessment, intervention, and feedback - have the potential to improve adherence. Our team previously developed and validated a novel urine-based POC metric of PrEP adherence. In this study, we sought to determine whether this assay is acceptable and feasible among women taking PrEP and PrEP providers in Kenya.

View Article and Find Full Text PDF

Background: The surgical management of complicated diverticulitis varies across Europe. EAES members prioritized this topic to be addressed by a clinical practice guideline through an online questionnaire.

Objective: To develop evidence-informed clinical practice recommendations for key stakeholders involved in the treatment of complicated diverticulitis; to improve operative and perioperative outcomes, patient experience and quality of life through a systematic evidence-to-decision approach by a diverse, multidisciplinary panel.

View Article and Find Full Text PDF

Access to health care is a fundamental human right. However, nearly one-third of the global population have no access to it. This magnitude is even much worse in low- and middle-income countries.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!