{"id":24212,"date":"2026-06-22T15:30:51","date_gmt":"2026-06-22T19:30:51","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=24212"},"modified":"2026-06-26T15:41:58","modified_gmt":"2026-06-26T19:41:58","slug":"application-of-a-novel-desirability-of-outcome-ranking-endpoint-incorporating-a-framework-for-resistance-assessment-and-microbiologic-evaluation-in-antibiotic-trials-a-proof-of-concept-in-a-post-hoc","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/application-of-a-novel-desirability-of-outcome-ranking-endpoint-incorporating-a-framework-for-resistance-assessment-and-microbiologic-evaluation-in-antibiotic-trials-a-proof-of-concept-in-a-post-hoc\/","title":{"rendered":"Application of a novel Desirability of Outcome Ranking endpoint incorporating a Framework for Resistance Assessment and Microbiologic Evaluation in antibiotic trials: a proof-of-concept in a post hoc analysis of the BALANCE trial"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 Desirability of Outcome Ranking (DOOR) with Response Adjusted for Duration of Antibiotic Risk (RADAR) has been suggested as an outcome for antibiotic duration trials. An endpoint incorporating a measure of antimicrobial resistance may better reflect trade-offs between different antibiotic strategies.<\/p>\n<p><strong>Methods<\/strong> \u2014 We constructed a novel endpoint, DOOR-FRAME (Framework for Resistance Assessment and Microbiologic Evaluation), and applied it as a proof-of-concept in a post hoc analysis of the BALANCE trial comparing 7- versus 14-day antibiotic duration for uncomplicated non-Staphylococcus aureus bloodstream infection (BSI). The DOOR comprised mortality, readmission, and reinfection, while the FRAME component was a quantitative composite measure of incident Clostridioides difficile infection (CDI) and positive cultures for antibiotic-resistant organisms (AROs). We included BALANCE patients in Ontario who consented to data linkage to provincial health administrative databases. We calculated the probabilistic index (PI), the probability of a randomly selected patient in the 7-day group having a better outcome at 180 days.<\/p>\n<p><strong>Results<\/strong> \u2014 Two hundred seventy-one participants were included. The DOOR distributions were similar between the 7- and 14-day groups, with PI of 46.8% (95% CI 40.4%\u201353.2%) using DOOR alone. Nine (6.9%) and 12 (8.5%) patients in the 7 and 14-day group respectively had ARO\/CDI within 180 days. Probabilistic index was 53.6% (95% CI 46.7%\u201360.4%) with DOOR-RADAR and 47.4% (95% CI 40.9%\u201353.8%) with DOOR-FRAME.<\/p>\n<p><strong>Conclusions<\/strong> \u2014 There were no significant differences in DOOR outcomes at 180 days between patients with uncomplicated BSI treated with 7 versus 14-day antibiotic duration. Incorporating a novel measure of antimicrobial resistance did not change interpretation of the trial.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 Desirability of Outcome Ranking (DOOR) with Response Adjusted for Duration of Antibiotic Risk (RADAR) has been suggested as an outcome for antibiotic duration trials. An endpoint incorporating a measure of antimicrobial resistance may better reflect trade-offs between different antibiotic strategies. Methods \u2014 We constructed a novel endpoint, DOOR-FRAME (Framework for Resistance Assessment and [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[56,35,58,66],"migration-helper-qa-sample-set":[],"class_list":["post-24212","journal_article","type-journal_article","status-publish","hentry","topic-pharmacoepidemiology-and-drug-safety","topic-public-health","topic-research-and-methods","topic-trials"],"acf":{"citation":"Ong SWX, Patrikar A, Pinto R, Mahar RK, Rishu A, Davis JS, Fowler RA, Tong SYC, Daneman N. <em>Open Forum Infect Dis<\/em>. 2026; 13(6): ofag142.","source_url":"https:\/\/doi.org\/10.1093\/ofid\/ofag142","ices_scientist":[1234,1215],"site":[6733],"research_program":[6745],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Application of a novel Desirability of Outcome Ranking endpoint incorporating a Framework for Resistance Assessment and Microbiologic Evaluation in antibiotic trials: a proof-of-concept in a post hoc analysis of the BALANCE trial<\/title>\n<meta name=\"description\" content=\"Background \u2014 Desirability of Outcome Ranking (DOOR) with Response Adjusted for Duration of Antibiotic Risk (RADAR) has been suggested as an outcome for\" \/>\n<meta name=\"robots\" content=\"index, follow, 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