PMID- 33484408 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210329 IS - 2193-8229 (Print) IS - 2193-6382 (Electronic) IS - 2193-6382 (Linking) VI - 10 IP - 1 DP - 2021 Mar TI - Using an Ordinal Approach to Compare Outcomes Between Vancomycin Versus Ceftaroline or Daptomycin in MRSA Bloodstream Infection. PG - 605-612 LID - 10.1007/s40121-021-00401-1 [doi] AB - 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. FAU - Barlow, Ashley AU - Barlow A AD - University of Maryland Medical Center, Baltimore, MD, USA. FAU - Heil, Emily L AU - Heil EL AD - University of Maryland Medical Center, Baltimore, MD, USA. AD - University of Maryland School of Pharmacy, Baltimore, MD, USA. FAU - Claeys, Kimberly C AU - Claeys KC AUID- ORCID: 0000-0001-6895-604X AD - University of Maryland Medical Center, Baltimore, MD, USA. kclaeys@rx.umaryland.edu. AD - University of Maryland School of Pharmacy, Baltimore, MD, USA. kclaeys@rx.umaryland.edu. LA - eng PT - Journal Article DEP - 20210123 PL - New Zealand TA - Infect Dis Ther JT - Infectious diseases and therapy JID - 101634499 PMC - PMC7954948 OTO - NOTNLM OT - Daptomycin OT - Desirability of outcomes ranking OT - S. aureus bacteremia OT - Vancomycin EDAT- 2021/01/24 06:00 MHDA- 2021/01/24 06:01 PMCR- 2021/01/23 CRDT- 2021/01/23 12:07 PHST- 2020/12/07 00:00 [received] PHST- 2021/01/09 00:00 [accepted] PHST- 2021/01/24 06:00 [pubmed] PHST- 2021/01/24 06:01 [medline] PHST- 2021/01/23 12:07 [entrez] PHST- 2021/01/23 00:00 [pmc-release] AID - 10.1007/s40121-021-00401-1 [pii] AID - 401 [pii] AID - 10.1007/s40121-021-00401-1 [doi] PST - ppublish SO - Infect Dis Ther. 2021 Mar;10(1):605-612. doi: 10.1007/s40121-021-00401-1. Epub 2021 Jan 23.