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

Simple item page
dc.contributor.authorPetersiel, N.
dc.contributor.authorDavis, J.S.
dc.contributor.authorMeagher, N.
dc.contributor.authorPrice, D.J.
dc.contributor.authorTong, S.Y.C.
dc.contributor.authorLye, D.C.
dc.contributor.authorYahav, D.
dc.contributor.authorSud, A.
dc.contributor.authorRobinson, J.O.
dc.contributor.authorNelson, J.
dc.contributor.authorArchuleta, S.
dc.contributor.authorRoberts, M.A.
dc.contributor.authorCass, A.
dc.contributor.authorPaterson, D.L.
dc.contributor.authorFoo, H.
dc.contributor.authorPaul, M.
dc.contributor.authorGuy, S.D.
dc.contributor.authorTramontana, A.R.
dc.contributor.authorWalls, G.B.
dc.contributor.authorMcbride, S.
dc.contributor.authoret al.
dc.date.issued2024
dc.description.abstractBackground: 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 methicillinresistant 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.
dc.description.statementofresponsibilityNeta Petersiel, Joshua S. Davis, Niamh Meagher, David J. Price, and Steven Y. C. Tong; for the Combination Antibiotics for MEthicillin Resistant Staphylococcus aureus (CAMERA2) Study Groupa
dc.identifier.citationOpen Forum Infectious Diseases, 2024; 11(5):ofae181-1-ofae181-8
dc.identifier.doi10.1093/ofid/ofae181
dc.identifier.issn2328-8957
dc.identifier.issn2328-8957
dc.identifier.orcidWarner, M.S. [0000-0002-4053-1610]
dc.identifier.urihttps://hdl.handle.net/2440/147929
dc.language.isoen
dc.publisherOxford University Press
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1078930
dc.rights© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.source.urihttp://dx.doi.org/10.1093/ofid/ofae181
dc.subjectbacteremia; bloodstream infection; DOOR; methicillin-resistant Staphylococcus aureus; MRSA.
dc.titleCombination 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
dc.title.alternativeCombination of Antistaphylococcal beta-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
dc.typeJournal article
pubs.publication-statusPublished

Files

Collections

Research Outputs