{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:57:34Z","timestamp":1790888254293,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T00:00:00Z","timestamp":1706832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001794","name":"University of Queensland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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 &amp;lt;1 favors meropenem. Further analyses were performed to calculate the win odds and to introduce a continuous outcome variable in order to reduce ties.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>With the hierarchy of all-cause mortality, microbiological relapse, and secondary infection, the win ratio estimate was 0.40 (95% confidence interval [CI], .22\u2013.71]; 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\u2013.92). 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\u2013.99; P = .04).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The application of the win ratio methodology to the MERINO trial data illustrates its utility and feasibility for use in antimicrobial trials.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae050","type":"journal-article","created":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T20:36:07Z","timestamp":1706906167000},"page":"1482-1489","source":"Crossref","is-referenced-by-count":15,"title":["Win Ratio Analyses of Piperacillin-Tazobactam Versus Meropenem for Ceftriaxone-Nonsusceptible <i>Escherichia coli<\/i> or <i>Klebsiella pneumoniae<\/i> Bloodstream Infections: Post Hoc Insights From the MERINO Trial"],"prefix":"10.1093","volume":"78","author":[{"given":"Melissa","family":"Hardy","sequence":"first","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick N A","family":"Harris","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland , Brisbane, Queensland ,","place":["Australia"]},{"name":"Central Microbiology Laboratory, Pathology Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2079-4437","authenticated-orcid":false,"given":"David L","family":"Paterson","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland , Brisbane, Queensland ,","place":["Australia"]},{"name":"ADVANCE-ID, Saw Swee Hock School of Public Health , National University of Singapore ,","place":["Singapore"]},{"name":"Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore ,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D","family":"Chatfield","sequence":"additional","affiliation":[{"name":"UQ Centre for Clinical Research, The University of Queensland , Brisbane, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Mo","sequence":"additional","affiliation":[{"name":"ADVANCE-ID, Saw Swee Hock School of Public Health , National University of Singapore ,","place":["Singapore"]},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford ,","place":["United Kingdom"]},{"name":"Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University , Bangkok 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