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    Using an Ordinal Approach to Compare Outcomes Between Vancomycin Versus Ceftaroline or Daptomycin in MRSA Bloodstream Infection.

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    Author
    Barlow, Ashley
    Heil, Emily L
    Claeys, Kimberly C
    Date
    2021-01-23
    Journal
    Infectious Diseases and Therapy
    Publisher
    Adis
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1007/s40121-021-00401-1
    Abstract
    Introduction: Vancomycin remains first-line therapy for methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI); however, its toxicity and reported clinical failures are well established. Binary efficacy endpoints evaluating alternative anti-MRSA therapies leave clinicians deciphering between segregated clinical and safety outcomes and do not provide a comprehensive patient-centered picture of comparative therapies. This study aimed to apply a novel methodology, desirability of outcomes ranking (DOOR), to compare anti-MRSA therapies. Methods: This was a single-centered, retrospective, cohort of adult patients with MRSA BSI that received vancomycin, daptomycin, or ceftaroline. A previously developed DOOR for S. aureus BSI was adjusted and applied to this cohort to compare vancomycin-treated versus daptomycin/ceftaroline-treated patients. The DOOR had five mutually exclusive ranks: (1) alive without treatment failure, infectious complications, or grade 4 adverse events (AEs); (2) alive with any one of treatment failure, infectious complications, or grade 4 AE; (3) alive with two of treatment failure, infectious complications, or grade 4 AE; (4) alive with all three treatment failure, infectious complications, or grade 4 AE; or (5) deceased. Results: A total of 43 vancomycin-treated and 13 daptomycin/ceftaroline-treated patients were included. Baseline clinical characteristics were similar, except for higher median serum creatinine in the daptomycin/ceftaroline cohort (0.76 [IQR 0.57, 1.11] vs 1.36 [IQR 1.09, 1.91] mg/dL, P = 0.03). Patients in the daptomycin/ceftaroline cohort had a 92% probability of better outcome using DOOR methodology. Patients treated with daptomycin/ceftaroline experienced less MRSA BSI persistence (0% vs 13.9%), MRSA BSI recurrence (7.8% vs 25.6%), grade 4 AEs (23.1% vs 46.5%), and in-hospital mortality (0% vs 9.3%). Conclusions: Although limited by sample size, this study demonstrates the potential of DOOR to produce valuable, patient-centered results. Clinicians are encouraged to become familiar with appropriate use and interpretation of DOOR methodology as it will become an increasingly common endpoint in clinical trials.
    Keyword
    Daptomycin
    Desirability of outcomes ranking
    S. aureus bacteremia
    Vancomycin
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14707
    ae974a485f413a2113503eed53cd6c53
    10.1007/s40121-021-00401-1
    Scopus Count
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    UMB Open Access Articles 2021

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