Core Outcome Measures in Effectiveness Trials

Proposed primary endpoints for use in clinical trials that compare treatment options for bloodstream infection in adults: a consensus definition

General Information

OBJECTIVES: To define standardized endpoints to aid the design of trials that compare antibiotic therapies for bloodstream infections (BSI). METHODS: Prospective studies, randomized trials or registered protocols comparing antibiotic therapies for BSI, published from 2005 to 2016, were reviewed. Consensus endpoints for BSI studies were defined using a modified Delphi process. RESULTS: Different primary and secondary endpoints were defined for pilot (small-scale studies designed to evaluate protocol design, feasibility and implementation) and definitive trials (larger-scale studies designed to test hypotheses and influence clinical practice), as well as for Staphylococcus aureus and Gram-negative BSI. For pilot studies of S. aureus BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever, stable/improved Sequential Organ Failure Assessment (SOFA) score and clearance of blood cultures, with no microbiologically confirmed failure up to 90 days. For definitive S. aureus BSI studies, a primary outcome of success at 90 days was defined by survival and no microbiologically confirmed failure. For pilot studies of Gram-negative BSI, a primary outcome of success at day 7 was defined by: survival, resolution of fever and symptoms related to BSI source, stable or improved SOFA score and negative blood cultures. For definitive Gram-negative BSI studies, a primary outcome of survival at 90 days supported by a secondary outcome of success at day 7 (as previously defined) was agreed. CONCLUSIONS: These endpoints provide a framework to aid future trial design. Further work will be required to validate these endpoints with respect to patient-centred clinical outcomes.

Harris, P. N. A. McNamara, J. F. Lye, D. C. Davis, J. S. Bernard, L. Cheng, A. C. Doi, Y. Fowler, V. G., Jr. Kaye, K. S. Leibovici, L. Lipman, J. Llewelyn, M. J. Munoz-Price, S. Paul, M. Peleg, A. Y. Rodriguez-Bano, J. Rogers, B. A. Seifert, H. Thamlikitkul, V. Thwaites, G. Tong, S. Y. C. Turnidge, J. Utili, R. Webb, S. A. R. Paterson, D. L.


Clin Microbiol Infect
533 - 541
Further Study Information

Funding source(s):

Health Area

Disease Category
Infectious disease

Disease Name
Bloodstream infections

Target Population

Age Range
18 - 100


Nature / type of Intervention


Focus group(s)
Systematic review

Stakeholders Involved

Clinical experts

Study Type

COS for clinical trials or clinical research

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