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DOOR framework shows similar outcomes in skin infection trials

“Using DOOR can provide clinicians and patients with a better understanding of the benefits and risks of new anti-infectives being studied to treat skin infections.” 

  • By

  • Matthew Solan

  • August 24, 2026

  • 7 min

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Clinical Report: DOOR framework shows similar outcomes in skin infection trials

Overview

A retrospective study applying the DOOR framework found that omadacycline and linezolid produced similar outcomes in treating acute bacterial skin and skin structure infections among 1,347 participants from two trials. The DOOR analysis indicated no statistically significant differences in treatment outcomes between the two antibiotics.

Background

Acute bacterial skin and skin structure infections (ABSSSI) are common and can lead to significant morbidity. This study evaluates the effectiveness of omadacycline compared to linezolid using a patient-centered approach.

Data Highlights

TrialDOOR Probability (Omadacycline vs Linezolid)95% Confidence Interval
OASIS-150.6%47.4%-53.7%
OASIS-252.1%49.2%-55.0%

Key Findings

  • About 80% of patients in both trials achieved the most desirable DOOR outcome.
  • The DOOR distribution between treatment arms was similar for both omadacycline and linezolid.
  • Absence of clinical response, infectious complications, and nonfatal serious adverse events were uncommon.
  • In OASIS-2, patients with diabetes had a 58.1% probability of a more desirable outcome with omadacycline.
  • No significant treatment differences were found for any individual DOOR component.

Clinical Implications

The DOOR framework provides a method for evaluating treatment outcomes in ABSSSI.

Conclusion

The application of the DOOR framework in this study highlights the comparable effectiveness of omadacycline and linezolid in treating ABSSSI.

Related Resources & Content

  1. Open Forum Infectious Diseases, 2023 -- DOOR framework shows similar outcomes in skin infection trials
  2. Open Forum Infectious Diseases — Framework for Ranking Desired Outcomes in Clinical Trials of Invasive Fungal Infections
  3. American Journal of Epidemiology — Assessing the Appeal of Outcome Ranking and Response Adjusted for Antibiotic Duration Risk in Pediatric Pneumonia Clinical Trials
  4. Open Forum Infectious Diseases — Impact of Postponing Surgical Treatment in Adults with Native Joint Septic Arthritis
  5. Intensive Care Medicine — Impact of Daily Octenidine Antiseptic Bathing on Bacteremia and Multidrug-Resistant Organisms in ICU Settings: A Multicenter, Cluster-Randomized, Double-Blind, Placebo-Controlled, Crossover Investigation
  6. IDSA 2014 Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections
  7. Omadacycline for the treatment of acute bacterial skin and skin structure infections: a systematic review and network meta-analysis
  8. oup.silverchair-cdn.com
  9. Antimicrobial use and resistance
  10. 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 | Open Forum Infectious Diseases | Oxford Academic

Original Source(s)

DOOR framework shows similar outcomes in skin infection trials

  • by Matthew Solan

  • August 24, 2026

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