Abstract
Desirability of outcome ranking (DOOR) has been developed for assessing desirability of outcome in interventional studies. However, its possible use in observational studies of the diagnosis and early treatment of infectious diseases has not been explored so far, and it might introduce interesting features in specific scenarios. This was a post hoc analysis of a prospective observational study in intensive care unit patients with sepsis and at risk of candidemia. The probabilities that a randomly selected patient would have a more, less, and equally cost-effective early therapeutic choice following a BDG-based diagnostic strategy rather than the empirical administration of antifungals to all patients were calculated using DOOR methods. The probability of a more cost-effective therapeutic choice following the BDG-based rather than the empirical strategy was 67.81% (95% CI 67.32–68.30), whereas the probabilities of a less and equally cost-effective early therapeutic choice were 19.68% (95% CI 19.27–20.10) and 12.50% (95% CI 12.16–12.85), respectively. The application of DOOR methods to observational studies focused on diagnosis and early treatment is a novel field that could merit further investigation.
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References
Evans SR, Rubin D, Follmann D et al (2015) Desirability of outcome ranking (DOOR) and response adjusted for days of antibiotic risk (RADAR). Clin Infect Dis 61:800–806
Celestin AR, Odom SR, Angelidou K et al (2017) Novel method suggests global superiority of short-duration antibiotics for intra-abdominal infections. Clin Infect Dis 65:1577–1579
Posteraro B, Tumbarello M, De Pascale G et al (2016) (1,3)-b-D-glucan-based antifungal treatment in critically ill adults at high risk of candidaemia: an observational study. J Antimicrob Chemother 71:2262–2269
Leon C, Ruiz-Santana S, Saavedra P et al (2009) Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med 37:1624–1633
Evans S, Follmann D, Schoenfeld D et al (2016) Reply to Phillips, Morris, and Walker. Clin Infect Dis 62:815–816
Phillips PP, Morris TP, Walker AS (2016) DOOR/RADAR: a gateway into the unknown? Clin Infect Dis 62:814–815
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Giacobbe, D.R., Signori, A., Tumbarello, M. et al. Desirability of outcome ranking (DOOR) for comparing diagnostic tools and early therapeutic choices in patients with suspected candidemia. Eur J Clin Microbiol Infect Dis 38, 413–417 (2019). https://doi.org/10.1007/s10096-018-3441-1
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DOI: https://doi.org/10.1007/s10096-018-3441-1