@article{c1eadf8536c04ba6b1f9fa343da7782d,
title = "Combination of Antistaphylococcal β-Lactam With Standard Therapy Compared to Standard Therapy Alone for the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia: A Post Hoc Analysis of the CAMERA2 Trial Using a Desirability of Outcome Ranking Approach",
abstract = "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 Staphylococcus aureus 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%; P =. 11) probability and a 1.2-fold odds (95% CI,. 95-1.50; P =. 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.",
keywords = "DOOR, MRSA, bacteremia, bloodstream infection, methicillin-resistant Staphylococcus aureus",
author = "Neta Petersiel and Davis, {Joshua S.} and Niamh Meagher and Price, {David J.} and Tong, {Steven Y.C.} and Lye, {David C.} and Dafna Yahav and Archana Sud and Robinson, {J. Owen} and Jane Nelson and Sophia Archuleta and Roberts, {Matthew A.} and Alan Cass and Paterson, {David L.} and Hong Foo and Mical Paul and Guy, {Stephen D.} and Tramontana, {Adrian R.} and Walls, {Genevieve B.} and Stephen Mcbride and Narin Bak and Niladri Ghosh and Rogers, {Benjamin A.} and Ralph, {Anna P.} and Jane Davies and Ferguson, {Patricia E.} and Ravindra Dotel and Mckew, {Genevieve L.} and Gray, {Timothy J.} and Holmes, {Natasha E.} and Simon Smith and Warner, {Morgyn S.} and Shirin Kalimuddin and Young, {Barnaby E.} and Naomi Runnegar and Andresen, {David N.} and Anagnostou, {Nicholas A.} and Johnson, {Sandra A.} and Chatfield, {Mark D.} and Cheng, {Allen C.} and Fowler, {Vance G.} and Howden, {Benjamin P.} and Niamh Meagher and Price, {David J.} and {Van Hal}, {Sebastiaan J.} and Sullivan, {Matthew V.N.O.}",
note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Published by Oxford University Press on behalf of Infectious Diseases Society of America.",
year = "2024",
month = may,
day = "1",
doi = "10.1093/ofid/ofae181",
language = "אנגלית",
volume = "11",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "5",
}
