Win Ratio Analyses of Piperacillin-Tazobactam Versus Meropenem for Ceftriaxone-Nonsusceptible Escherichia coli or Klebsiella pneumoniae Bloodstream Infections: Post Hoc Insights From the MERINO Trial
Issued Date
2024-06-15
Resource Type
ISSN
10584838
eISSN
15376591
Scopus ID
2-s2.0-85193062378
Pubmed ID
38306577
Journal Title
Clinical Infectious Diseases
Volume
78
Issue
6
Start Page
1482
End Page
1489
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Infectious Diseases Vol.78 No.6 (2024) , 1482-1489
Suggested Citation
Hardy M., Harris P.N.A., Paterson D.L., Chatfield M.D., Mo Y., Tambyah P.A., Lye D.C., Lee T.H., Yilmaz M., Alenazi T.H., Arabi Y., Falcone M., Bassetti M., Righi E., Rogers B.A., Kanj S., Bhally H., Iredell J., Mendelson M., Boyles T.H., Looke D., Miyakis S., Walls G., Al Khamis M., Zikri A., Crowe A., Ingram P., Daneman N., Griffin P., Athan E., Lorenc P., Baker P., Roberts L., Beatson S.A., Harris-Brown T., Peleg A.Y. Win Ratio Analyses of Piperacillin-Tazobactam Versus Meropenem for Ceftriaxone-Nonsusceptible Escherichia coli or Klebsiella pneumoniae Bloodstream Infections: Post Hoc Insights From the MERINO Trial. Clinical Infectious Diseases Vol.78 No.6 (2024) , 1482-1489. 1489. doi:10.1093/cid/ciae050 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98996
Title
Win Ratio Analyses of Piperacillin-Tazobactam Versus Meropenem for Ceftriaxone-Nonsusceptible Escherichia coli or Klebsiella pneumoniae Bloodstream Infections: Post Hoc Insights From the MERINO Trial
Author(s)
Hardy M.
Harris P.N.A.
Paterson D.L.
Chatfield M.D.
Mo Y.
Tambyah P.A.
Lye D.C.
Lee T.H.
Yilmaz M.
Alenazi T.H.
Arabi Y.
Falcone M.
Bassetti M.
Righi E.
Rogers B.A.
Kanj S.
Bhally H.
Iredell J.
Mendelson M.
Boyles T.H.
Looke D.
Miyakis S.
Walls G.
Al Khamis M.
Zikri A.
Crowe A.
Ingram P.
Daneman N.
Griffin P.
Athan E.
Lorenc P.
Baker P.
Roberts L.
Beatson S.A.
Harris-Brown T.
Peleg A.Y.
Harris P.N.A.
Paterson D.L.
Chatfield M.D.
Mo Y.
Tambyah P.A.
Lye D.C.
Lee T.H.
Yilmaz M.
Alenazi T.H.
Arabi Y.
Falcone M.
Bassetti M.
Righi E.
Rogers B.A.
Kanj S.
Bhally H.
Iredell J.
Mendelson M.
Boyles T.H.
Looke D.
Miyakis S.
Walls G.
Al Khamis M.
Zikri A.
Crowe A.
Ingram P.
Daneman N.
Griffin P.
Athan E.
Lorenc P.
Baker P.
Roberts L.
Beatson S.A.
Harris-Brown T.
Peleg A.Y.
Corresponding Author(s)
Other Contributor(s)
Abstract
Background. Clinical trials of treatments for serious infections commonly use the primary endpoint of all-cause mortality. However, many trial participants survive their infection and this endpoint may not truly reflect important benefits and risks of therapy. The win ratio uses a hierarchical composite endpoint that can incorporate and prioritize outcome measures by relative clinical importance. Methods. The win ratio methodology was applied post hoc to outcomes observed in the MERINO trial, which compared piperacillin-tazobactam with meropenem. We quantified the win ratio with a primary hierarchical composite endpoint, including all-cause mortality, microbiological relapse, and secondary infection. A win ratio of 1 would correspond to no difference between the 2 antibiotics, while a ratio <1 favors meropenem. Further analyses were performed to calculate the win odds and to introduce a continuous outcome variable in order to reduce ties. Results. With the hierarchy of all-cause mortality, microbiological relapse, and secondary infection, the win ratio estimate was 0.40 (95% confidence interval [CI], .22-.71]; P = .002), favoring meropenem over piperacillin-tazobactam. However, 73.4% of the pairs were tied due to the small proportion of events. The win odds, a modification of the win ratio accounting for ties, was 0.79 (95% CI, .68-.92). The addition of length of stay to the primary composite greatly minimized the number of ties (4.6%) with a win ratio estimate of 0.77 (95% CI, .60-.99; P = .04). Conclusions. The application of the win ratio methodology to the MERINO trial data illustrates its utility and feasibility for use in antimicrobial trials.
