A Desirability of Outcome Ranking Analysis of a Randomized Clinical Trial Comparing Seven Versus Fourteen Days of Antibiotics for Uncomplicated Gram-Negative Bloodstream Infection

被引：13

作者：

Howard-Anderson, Jessica ^{[1
]}

Dai, Weixiao ^{[2
,3
]}

Yahav, Dafna ^{[4
,5
]}

Hamasaki, Toshimitsu ^{[2
,3
]}

Turjeman, Adi ^{[5
,6
]}

Koppel, Fidi ^{[7
]}

Franceschini, Erica ^{[8
]}

Hill, Carol ^{[9
]}

Sund, Zoe ^{[9
]}

Chambers, Henry F. ^{[10
]}

Fowler, Vance G. ^{[9
,11
]}

Boucher, Helen W. ^{[12
]}

Evans, Scott R. ^{[2
,3
]}

Paul, Mical ^{[7
,13
]}

Holland, Thomas L. ^{[9
,11
]}

Doernberg, Sarah B. ^{[10
]}

机构：

[1] Emory Univ, Dept Med, Div Infect Dis, Sch Med, Atlanta, GA 30322 USA

[2] George Washington Univ, Biostat Ctr, Milken Inst, Sch Publ Hlth, Washington, DC USA

[3] George Washington Univ, Dept Biostat & Bioinformat, Milken Inst, Sch Publ Hlth, Washington, DC USA

[4] Beilinson Med Ctr, Rabin Med Ctr, Unit Infect Dis, Petah Tiqwa, Israel

[5] Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel

[6] Beilinson Med Ctr, Rabin Med Ctr, Dept Med E, Petah Tiqwa, Israel

[7] Inst Infect Dis, Rambam Hlth Care Campus, Haifa, Israel

[8] Univ Modena & Reggio Emilia, Clin Infect Dis, Modena, Italy

[9] Duke Clin Res Inst, Durham, NC USA

[10] Univ Calif San Francisco, Dept Internal Med, Div Infect Dis, San Francisco, CA USA

[11] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA

[12] Tufts Med Ctr, Div Geog Med & Infect Dis, Boston, MA USA

[13] Technion Israel Inst Technol, Fac Med, Haifa, Israel

来源：

OPEN FORUM INFECTIOUS DISEASES | 2022年 / 9卷 / 06期

基金：

美国国家卫生研究院;

关键词：

antibiotics; desirability of outcome ranking; Gram-negative bacteremia; treatment duration; ANTIMICROBIAL RESISTANCE; DURATION;

D O I：

10.1093/ofid/ofac140

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background Although a short course (7 days) of antibiotics has been demonstrated to be noninferior to a conventional course (14 days) in terms of mortality and infectious complications for patients with a Gram-negative bacterial bloodstream infection (GNB), it is unknown whether a shorter treatment duration can provide a better overall clinical outcome. Methods We applied a bloodstream infection-specific desirability of outcome ranking (DOOR) analysis to the results of a previously completed, randomized controlled trial comparing short versus conventional course antibiotic therapy for hospitalized patients with uncomplicated GNB. We determined the probability that a randomly selected participant in the short course group would have a more desirable overall outcome than a participant in the conventional duration group. We performed (1) partial credit analyses allowing for calculated and variable weighting of DOOR ranks and (2) subgroup analyses to elucidate which patients may benefit the most from short durations of therapy. Results For the 604 patients included in the original study (306 short course, 298 conventional course), the probability of having a more desirable outcome with a short course of antibiotics compared with a conventional course was 51.1% (95% confidence interval, 46.7% to 55.4%), indicating no significant difference. Partial credit analyses indicated that the DOOR results were similar across different patient preferences. Prespecified subgroup analyses using DOOR did not reveal significant differences between short and conventional courses of therapy. Conclusions Both short and conventional durations of antibiotic therapy provide comparable clinical outcomes when using DOOR to consider benefits and risks of treatment options for GNB. We retrospectively applied a desirability of outcome ranking analysis to a randomized controlled trial comparing short versus conventional durations of antibiotics for Gram-negative bacteremia. A short duration of antibiotics provided similar desirability of clinical outcomes as a conventional duration.

引用

页数：7

共 19 条

[1] Good Studies Evaluate the Disease While Great Studies Evaluate the Patient: Development and Application of a Desirability of Outcome Ranking Endpoint for Staphylococcus aureus Bloodstream Infection [J].