How Generalizable Are Randomized Controlled Trials (RCTs) in Staphylococcus aureus Bacteremia? A Description of the Mortality Gap Between RCTs and Observational Studies

Anthony D Bai; Carson K L Lo; Adam S Komorowski; Mallika Suresh; Kevin Guo; Akhil Garg; Pranav Tandon; Julien Senecal; Olivier Del Corpo; Isabella Stefanova; Clare Fogarty; Guillaume Butler-Laporte; Emily G McDonald; Matthew P Cheng; Andrew M Morris; Mark Loeb; Todd C Lee

doi:10.1093/cid/ciac177

How Generalizable Are Randomized Controlled Trials (RCTs) in Staphylococcus aureus Bacteremia? A Description of the Mortality Gap Between RCTs and Observational Studies

Clin Infect Dis. 2022 Oct 12;75(8):1449-1452. doi: 10.1093/cid/ciac177.

Authors

Anthony D Bai^{1

2}, Carson K L Lo³, Adam S Komorowski^{2

4}, Mallika Suresh⁵, Kevin Guo⁶, Akhil Garg⁷, Pranav Tandon⁸, Julien Senecal⁹, Olivier Del Corpo¹⁰, Isabella Stefanova⁵, Clare Fogarty¹¹, Guillaume Butler-Laporte¹², Emily G McDonald¹³, Matthew P Cheng¹⁴, Andrew M Morris¹⁵, Mark Loeb^{2

3

4}, Todd C Lee¹³

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
² Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
³ Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁶ Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Medicine, Queen's University, Kingston, Ontario, Canada.
⁸ Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁹ Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
¹⁰ Department of Medicine, Division of Experimental Medicine, Division of Infectious Diseases, McGill University, Montréal, QC, Canada.
¹¹ McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
¹² Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
¹³ Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada.
¹⁴ Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Quebec, Canada.
¹⁵ Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and the University of Toronto, Toronto, Canada.

PMID: 35243486
DOI: 10.1093/cid/ciac177

Abstract

In Staphylococcus aureus bacteremia, mortality rates in randomized controlled trials (RCTs) are consistently lower than observational studies. Stringent eligibility criteria and omission of early deaths in RCTs contribute to this mortality gap. Clinicians should acknowledge the possibility of a lower treatment effect when applying RCT results to bedside care.

Keywords: Staphylococcus aureus; bacteremia; mortality; trials.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Bacteremia* / drug therapy
Humans
Randomized Controlled Trials as Topic
Staphylococcal Infections* / drug therapy
Staphylococcus aureus

Substances

Anti-Bacterial Agents