Sean Ong
ID doc and joint PhD candidate at University of Toronto + University of Melbourne. Talk to me about clinical trial design and methodology, bloodstream infections, S. aureus, and Gram negatives 🦠
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- Reposted by Sean OngThe 3rd and 4th commentaries on recent ID trials are up on the CLARITY website (we aim to publish in depth reviews of important ID stuies). This time looking at the GAMECHANGER trial: clarityinitiative.org/commentaries... @erinmccreary.bsky.social with Ahmad Mourad @gurujosh.bsky.social #IDSky
- Reposted by Sean OngNew article about how to manage Staphylococcus aureus bacteremia. Led by Hadar Mudrik-Zohar. Includes @seanong.bsky.social @drtoddlee.bsky.social #IDSky #SNAP_trial www.sciencedirect.com/science/arti...
- A group of ID clinical researchers passionate about clinical research and evidence appraisal has just launched the CLARITY initiative (clarityinitiative.org), which aims to improve the generation and interpretation of evidence in ID and Microbiology.
- We will publish regular commentaries on new RCTs in ID/Micro, with a focus on methodologic aspects of these studies. A course focused on clinical trials design and methodology is in the works and will run Nov 2026; keep a look out for that. Read more here: doi.org/10.1016/j.cm...
- Our first published commentary on the DOTS trial explains the use of the DOOR outcome and discusses the benefits and drawbacks associated with using this outcome. www.cmi-comms.org/article/S295...
- Our new paper in @cmijournal.bsky.social: www.clinicalmicrobiologyandinfection.org/article/S119... We use the BALANCE and CAMERA2 trials as case studies to illustrate the use of the different methods available for analysis of hierarchical composite endpoints. #IDSky @steventong.bsky.social
- This article is a companion piece to our previous review on hierarchical composite endpoints (HCEs) (doi.org/10.1093/cid/...), where we provided a conceptual overview of HCEs and explained the different analytic methods and possible target parameters associated with their use.
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- Reposted by Sean Ong@seanong.bsky.social is giving his PhD oration today at 12.30pm AEDT. If you are free, you will learn heaps about clinical trials in infectious diseases. It's been an incredible PhD journey! unimelb.zoom.us/j/8944229688... @thedohertyinst.bsky.social
- Reposted by Sean OngNew Research Accounting for non-adherence to assigned antibiotic treatment duration for bloodstream infection (BALANCE): a post-hoc analysis of a randomised clinical trial www.thelancet.com/journals/lan...
- Hot off the press at @thelancetinfdis.bsky.social: our paper diving into non-adherence in the BALANCE trial. We identify factors associated with protocol non-adherence, and evaluate the impact of potential bias on trial results. authors.elsevier.com/a/1m5He5E-Uo... @steventong.bsky.social #IDSky
- 2/ Non-adherence, especially with the treatment crossover pattern, is a threat to internal validity in non-inferiority trials, since it biases results towards no difference between groups, increasing the probability of a false conclusion of non-inferiority.
- 3/ However, intention-to-treat and per-protocol approaches are both not ideal and do not adequately address this bias. There is no good consensus in guidelines or reporting standards on how best to address this non-adherence; though a variety of statistical techniques have been described.
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View full thread10/ Our work provides an illustrative example of how statistical methods can obtain adjusted effect estimates in the setting of non-adherence. Investigators should consider the potential impact of protocol non-adherence on their trial results and conduct relevant analyses specific to their context.
- We are looking for candidates for a new fully-funded joint PhD position at the Universities of Toronto and Melbourne, working on RCTs in bloodstream infection (BALANCE+, SNAP, STRAP). More info here: forms.gle/H9TXEMkwM1cb... Please spread far and wide! @steventong.bsky.social #IDSky
- I can't say enough how incredible my experience with this joint PhD program has been. The coursework at @ihpmeuoft.bsky.social is truly world-class, and this is also a great opportunity to work with some amazing clinical trialists and build an international collaborative network.
- I owe a lot to the site formerly known as Twitter (it's where I found my amazing joint PhD position thanks to a fortuitous post by @steventong.bsky.social), but it's completely unusable now and full of irrelevant material that I don't want to see. I no longer use it, and am firmly Team BlueSky!
- New pro/con perspective piece by @drneilstone.bsky.social & yours truly Joining the X-odus: Contrasting perspectives on whether infection specialists should leave X (formerly Twitter) That I'm sharing it here belies where I stand on the issue www.cmi-comms.org/article/S295... #IDSky
- Reposted by Sean OngDavid Paterson and the ADVANCE-ID team are doing a lot of work for us summarizing recent literature on bacterial & fungal infections & therapies. If you aren't already receiving their bimonthly newsletters, you should! ad-id.co/subscribe #IDSky #Clinmicro
- Our new paper in @cmijournal.bsky.social led by the brilliant Hadrien Moffroid, a junior colleague in Melbourne. We examined international funding flows in ID RCTs published in selected high-impact journals over a 10-year period. doi.org/10.1016/j.cm... @steventong.bsky.social #IDSky
- High-income countries fund a large majority of clinical trials in ID, with the NIH in particular funding 20% of trials in our review. Current changes in funding (especially the de-prioritisation of global health amongst some funders) has major implications on ID clinical trials worldwide.
- "Reduction in funding is likely to lead to reduced trial capacity, weakened surveillance, and delayed access to vaccines and therapeutics, and ultimately poorer global health outcomes."
- "Addressing these challenges requires rethinking funding models, fostering equitable collaborations, and strengthening LMIC research leadership, trial capacity and infrastructure —not just as a matter of justice and equity, but as a necessity for global health security."
- Reposted by Sean OngNew post-hoc Camera-2 📷 post-hoc analysis out today regarding adherence to quality metrics in MRSA bacteremia. Compared to similar non-trial population w/ MRSA bacteremia: -No difference in 🪦, BUT -non-trial had less following of quality metrics (see ⬇️) #IDSky jamanetwork.com/journals/jam...
- Glad to have the opportunity to collaborate with Spanish colleagues on this. We conducted a pooled Bayesian post-hoc analysis of the BACSARM and SAFO trials evaluating combination therapy with fosfomycin for SAB. The door may not be closed on adjunctive fosfomycin! Justifies need for more RCTs.
- Adjunctive Fosfomycin for the Treatment of Staphylococcus aureus Bacteremia: A Pooled Post-hoc Analysis of Individual Participant Data from Two Randomized Trials ✅ Just Accepted #IDSky
- This study was partly inspired after seeing a slide on @steventong.bsky.social's presentation about SAB trials at ESCMID 2024, after which we connected with the BACSARM and SAFO investigators to put this together. Conferences are a wonderful source of new project ideas and collaborations.
- Thankful for another opportunity to write this editorial with @steventong.bsky.social in @jama.com: jamanetwork.com/journals/jam... We discuss this trial, which evaluated the impact of different recruitment letter formats on RCT enrolment: jamanetwork.com/journals/jam...
- This is a fantastic example of a Study Within A Trial (SWAT), incorporating research on RCT methods within a larger clinical trial. We are currently conducting a similar SWAT, SIMPLY-SNAP, which looks at the impact of simplified layered consent on recruitment to SNAP: doi.org/10.1136/bmjo...
- Our review on hierarchical composite endpoints (HCEs) has just been published in @cidjournal.bsky.social: doi.org/10.1093/cid/... We provide a conceptual overview of HCEs, explain the different associated target parameters and analytic methods. @steventong.bsky.social @gurujosh.bsky.social
- 1/ HCEs combine features of composite and ordinal outcomes: they combine multiple clinical events (composite), but are also hierarchical as they establish a rank order of clinical importance across the different component events. A common example in ID is the DOOR outcome, a specific type of HCE.
- 2/ Studies using DOOR are often analyzed using the Mann-Whitney U test, comparing distribution of ranks across groups. This estimates the probability that a randomly selected patient in group 1 has a better outcome to one in group 2 (AKA probabilistic index). doi.org/10.1016/j.cm...
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View full thread8/ We tried to write this review in an approachable way for clinicians who may not be entirely comfortable with statistics. Hopefully it is useful to some folks. In a follow-up paper, we applied the different methods described in illustrative post-hoc analyses of BALANCE and CAMERA2. Stay tuned!
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- Honoured to be invited to write this commentary with @steventong.bsky.social, on an excellent target trial emulation study which showed that antibiotic use was not associated with improved outcomes in non-severe COVID-19. jamanetwork.com/journals/jam... #IDSky
- Reposted by Sean Ong🆕 Evaluating BSI in Ontario we found #AMR was associated with a 10% ⬆️ risk of death equivalent to 1.2 deaths/100,000 people/year These estimates are lower than those in previous literature, which may be due to robust adjustment for confounding doi.org/10.1093/cid/... @cidjournal.bsky.social
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- Reposted by Sean OngCefazolin vs Antistaphylococcal Penicillins for Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Systematic Review & Meta-Analysis @connorprosty.bsky.social @seanong.bsky.social &c Cefaz more effective, safer #idsky www.clinicalmicrobiologyandinfection.com/article/S119... 🔓
