Evidence map›Paper›PMID 38306577›Full record

Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024

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.

Melissa Hardy, Patrick N A Harris, David L Paterson, Mark D Chatfield, Yin Mo, MERINO Trial Investigators

Open access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
4.9field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 11 citations in OpenAlex.

  1. Making Sense of Hierarchical Composite End Points in Randomized Clinical Trials-A Primer for Infectious Diseases Clinicians and Researchers.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Review
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 5 countries.

Melissa HardyUQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
Patrick N A HarrisUQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
David L PatersonUQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.ORCID 0000-0003-2079-4437
Mark D ChatfieldUQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
Yin MoADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
MERINO Trial Investigators
The University of Queensland · AUNational University of Singapore · SGQueensland Health · AU

Funding

University of Queensland
6 · The paper itself

Abstract

backgroundClinical 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.

methodsThe 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.

resultsWith 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).

conclusionsThe application of the win ratio methodology to the MERINO trial data illustrates its utility and feasibility for use in antimicrobial trials.

Indexed as

Anti-Bacterial AgentsKlebsiella InfectionsKlebsiella pneumoniaeMeropenemPiperacillinPiperacillin, Tazobactam Drug CombinationAgedBacteremiaCeftriaxoneEscherichia coliEscherichia coli InfectionsFemaleHumansMaleMiddle AgedPenicillanic AcidAnti-Bacterial AgentsCeftriaxoneMeropenemPenicillanic AcidPiperacillinPiperacillin, Tazobactam Drug CombinationThienamycinsantimicrobial resistancebloodstream infectionshierarchical composite outcomerandomized controlled trialwin ratio

Identifiers

PMID38306577
PMCPMC11711476
OpenAlexW4391466401

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.