Workpackage 1-Combinations

Published

June 9, 2023

WORKPACKAGE 1B: EFFECT OF ANTIBIOTIC COMBINATIONS ON TPOS

METHODS

  • The activity of combination ceftazidime/avibactam (4 to 1 ratio from commercial formulation) plus gentamicin (0-4 mg/L) was tested against Klebsiella pneumonia KPCB strain in 5 replicate experiments using an array of test concentrations.

    Test array
  • The effect of the antibiotic combinations Tpos combination was analyzed using a Bliss Independence Model of drug interaction using a workflow described for the synergy analysis using the BIGL package.1

  • The first step of the fitting procedure analyzed marginal data only, i.e.-those observations within the experiment where one of the compounds is dosed at zero. For each compound the corresponding marginal doses are modelled using a 4-parameter logistic model

  • The marginal models will be estimated together using non-linear least squares estimation procedure. A simple sum-of-squared-residuals minimization driven by a default Nelder-Mead algorithm from optim minimizer was used.

  • Presence of synergistic or antagonistic effects was formalized by means of the meanR and maxR test. meanR test evaluates how the predicted response surface based on a specified null model differs from the observed one. If the null hypothesis is rejected, this test suggests that at least some dose combinations may exhibit synergistic or antagonistic behaviour. The meanR test is not designed to pinpoint which combinations produce these effects nor what type of deviating effect is present.

  • maxR test allows to evaluate presence of synergistic/antagonistic effects for each dose combination and as such provides a point-by-point classification.

RESULTS

Ceftazidime-avibactam + gentamicin

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  • The results shown in ?@fig-10wp2 demonstrated that CTZ/AVI + gentamicin is broadly synergistic over the range of tested concentrations, with an average 4.29 hr increase (95% CI 2.65-6.46) in Tpos versus the predicted null interactive response of ceftazidime-avibactam and gentamicin alone.
Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_gent_kpcb <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/caz_gent_kpcb.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFit <- fitMarginals(caz_gent_kpcb, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "GENT"))
summary(marginalFit)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              9.271 13.756
Maximal response  24.000 24.000
log10(EC50)        1.930  1.327

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime and gentamicin, minimum constrained at 9 hrs and maximum contrastined at 24 hours
plot(marginalFit) + ggtitle(paste("Ceftazidime/Avibactam + Gentamicin"))
rs <- fitSurface(caz_gent_kpcb, marginalFit,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              9.271 13.756
Maximal response  24.000 24.000
log10(EC50)        1.930  1.327

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
3.0477 [2.2481, 4.007]
Evidence for effects in data: Syn 

Significant pointwise effects
            estimate  lower   upper call
19.95_19.95   6.9764 2.0572 11.8957  Syn
39.9_19.95    9.4952 5.8848 13.1056  Syn
79.8_19.95    6.6173 2.5914 10.6432  Syn
79.8_4.9875   9.3826 2.0492 16.7161  Syn
79.8_9.975    8.9935 6.0041 11.9828  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   5   0    15
Code
plot(rs, legend = FALSE, main = "")
Figure 1: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 2: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
## mean R statistic evaluates how the test evaluates how the predicted response surface based on a specified null model differs from the observed one. If the null hypothesis is rejected, this test suggests that at least some dose combinations may exhibit synergistic or antagonistic behaviour. The meanR test is not designed to pinpoint which combinations produce these effects nor what type of deviating effect is present.
meanR_N <-fitSurface(caz_gent_kpcb, marginalFit, statistic="meanR",CP=rs$CP, B.B=20, parallel = FALSE)

# maxR test allows to evaluate presence of synergistic/antagonistic effects for each dose combination and as such provides a point-by-point classification.
maxR_N <- fitSurface(caz_gent_kpcb, marginalFit,
                     statistic = "maxR", CP = rs$CP, B.B = 20,
                     parallel = FALSE)
maxR_B <- fitSurface(caz_gent_kpcb, marginalFit,
                     statistic = "maxR", CP = rs$CP, B.B = 20,
                     parallel = FALSE)
maxR_both <- rbind(summary(maxR_N$maxR)$totals,
                   summary(maxR_B$maxR)$totals)

contour(maxR_B,
         ## colorPalette = c("blue", "black", "black", "red"),
        main = paste0(" Ceftazidime/Avibactam + Gentamicin"),
        scientific = TRUE, digits = 3, cutoff = cutoff)

plotConfInt(maxR_B, color ="effect-size")

rsh <- fitSurface(caz_gent_kpcb, marginalFit,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              9.271 13.756
Maximal response  24.000 24.000
log10(EC50)        1.930  1.327

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(15,87) = 22.8701 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
               d1      d2      absR p-value call
19.95_19.95 19.95 19.9500  4.641679   1e-04  Syn
39.9_19.95  39.90 19.9500 11.185995  <2e-16  Syn
79.8_19.95  79.80 19.9500  8.325151  <2e-16  Syn
79.8_4.9875 79.80  4.9875  4.136343 0.00111  Syn
79.8_9.975  79.80  9.9750 10.250631  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   5   0    15

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
3.2336 [2.1092, 4.1451]
Evidence for effects in data: Syn 

Significant pointwise effects
            estimate  lower   upper call
19.95_19.95   6.9765 3.1071 10.8459  Syn
39.9_19.95    9.5042 6.8960 12.1125  Syn
79.8_19.95    9.3826 6.3518 12.4135  Syn
79.8_4.9875   9.3826 3.1616 15.6037  Syn
79.8_9.975    8.9938 6.5390 11.4485  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   5   0    15
Code
rsb <- fitSurface(caz_gent_kpcb, marginalFit, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              9.271 13.756
Maximal response  24.000 24.000
log10(EC50)        1.930  1.327

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(15,87) = 17.7733 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
               d1      d2      absR p-value call
19.95_19.95 19.95 19.9500  4.116661 0.00138  Syn
39.9_19.95  39.90 19.9500 10.126517  <2e-16  Syn
79.8_19.95  79.80 19.9500  4.000327 0.00231  Syn
79.8_4.9875 79.80  4.9875  4.149137 0.00122  Syn
79.8_9.975  79.80  9.9750 10.372249  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   5   0    15

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
3.0477 [2.1585, 4.0323]
Evidence for effects in data: Syn 

Significant pointwise effects
            estimate  lower   upper call
19.95_19.95   6.9764 2.0906 11.8623  Syn
39.9_19.95    9.4952 6.1100 12.8804  Syn
79.8_19.95    6.6173 2.6989 10.5357  Syn
79.8_4.9875   9.3826 1.6980 17.0673  Syn
79.8_9.975    8.9935 5.9019 12.0850  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   5   0    15
Figure 3: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Figure 4: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Figure 5: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos


  • The activity of combination ceftazidime/avibactam (4 to 1 ratio from analytical powder) plus gentamicin was tested against Klebsiella pneumonia KPC_A strain in 5 replicate experiments using the same methodology.
  • Results are shown in ?@fig-11wp2 .

Download data

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_gent_kpca2 <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/kpca_gent_caz.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFit2 <- fitMarginals(caz_gent_kpca2, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "GENT"))
summary(marginalFit2)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              7.937  8.662
Maximal response  24.000 24.000
log10(EC50)        0.588  0.199

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime and gentamicin, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalFit2) + ggtitle(paste("Ceftazidime/Avibactam + Gentamicin"))
rs2 <- fitSurface(caz_gent_kpca2, marginalFit2,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs2)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              7.937  8.662
Maximal response  24.000 24.000
log10(EC50)        0.588  0.199

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
5.5514 [4.9162, 6.2709]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower   upper call
1.9_0.95     6.6045 4.4936  8.7154  Syn
1.9_1.425   10.2930 2.9105 17.6755  Syn
2.85_0.475  13.3292 6.4187 20.2398  Syn
2.85_0.95   13.1710 8.1373 18.2046  Syn
2.85_1.425   9.4954 2.1260 16.8648  Syn
3.8_0.0095   7.7899 0.7970 14.7828  Syn
3.8_0.0285   7.7899 0.7970 14.7828  Syn
3.8_0.2375   7.2899 3.4309 11.1488  Syn
3.8_0.475    7.5611 4.3937 10.7285  Syn
3.8_0.95     7.6972 4.8569 10.5375  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  10   0    18
Code
plot(rs2, legend = FALSE, main = "")
Figure 6: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 7: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
## mean R statistic evaluates how the test evaluates how the predicted response surface based on a specified null model differs from the observed one. If the null hypothesis is rejected, this test suggests that at least some dose combinations may exhibit synergistic or antagonistic behaviour. The meanR test is not designed to pinpoint which combinations produce these effects nor what type of deviating effect is present.
meanR_N2 <-fitSurface(caz_gent_kpca2, marginalFit2, statistic="meanR",CP=rs2$CP, B.B=20, parallel = FALSE)

# maxR test allows to evaluate presence of synergistic/antagonistic effects for each dose combination and as such provides a point-by-point classification.
maxR_N2 <- fitSurface(caz_gent_kpca2, marginalFit2,
                     statistic = "maxR", CP = rs2$CP, B.B = 20,
                     parallel = FALSE)
maxR_B2 <- fitSurface(caz_gent_kpca2, marginalFit2,
                     statistic = "maxR", CP = rs2$CP, B.B = 20,
                     parallel = FALSE)
maxR_both2 <- rbind(summary(maxR_N2$maxR)$totals,
                   summary(maxR_B2$maxR)$totals)

contour(maxR_B2,
         ## colorPalette = c("blue", "black", "black", "red"),
        main = paste0(" Ceftazidime/Avibactam + Gentamicin"),
        scientific = TRUE, digits = 3, cutoff = cutoff)

plotConfInt(maxR_B2, color ="effect-size")

rsh2 <- fitSurface(caz_gent_kpca2, marginalFit2,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh2)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              7.937  8.662
Maximal response  24.000 24.000
log10(EC50)        0.588  0.199

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(18,150) = 33.6972 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
             d1     d2      absR p-value call
1.9_0.95   1.90 0.9500 13.591463  <2e-16  Syn
1.9_1.425  1.90 1.4250  5.561332   1e-05  Syn
1.9_1.9    1.90 1.9000  4.861305   2e-05  Syn
2.85_0.475 2.85 0.4750  7.732139  <2e-16  Syn
2.85_0.95  2.85 0.9500 10.656374  <2e-16  Syn
2.85_1.425 2.85 1.4250  5.561332   1e-05  Syn
3.8_0.0095 3.80 0.0095  3.341910 0.01935  Syn
3.8_0.0285 3.80 0.0285  3.341910 0.01935  Syn
3.8_0.2375 3.80 0.2375  4.845663   2e-05  Syn
3.8_0.475  3.80 0.4750  6.340654  <2e-16  Syn
3.8_0.95   3.80 0.9500  7.681099  <2e-16  Syn
3.8_1.9    3.80 1.9000  3.825904 0.00349  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn  12   0    18

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
5.6804 [5.0922, 6.5342]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower   upper call
1.9_0.95     6.6547 4.4460  8.8634  Syn
1.9_1.425   10.3292 2.6111 18.0473  Syn
2.85_0.475  13.3296 5.9540 20.7052  Syn
2.85_0.95   13.3296 7.9390 18.7202  Syn
2.85_1.425  10.3292 2.6111 18.0473  Syn
3.8_0.0095   7.7899 0.2695 15.3103  Syn
3.8_0.0285   7.7899 0.2695 15.3103  Syn
3.8_0.2375   7.2899 2.9835 11.5963  Syn
3.8_0.475    7.5613 3.9399 11.1827  Syn
3.8_0.95     7.7899 4.4820 11.0978  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  10   0    18
Code
rsb2 <- fitSurface(caz_gent_kpca2, marginalFit2, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb2)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              7.937  8.662
Maximal response  24.000 24.000
log10(EC50)        0.588  0.199

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(18,150) = 35.2265 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
             d1     d2      absR p-value call
1.9_0.95   1.90 0.9500 13.202805  <2e-16  Syn
1.9_1.425  1.90 1.4250  5.658116  <2e-16  Syn
1.9_1.9    1.90 1.9000  4.869663   2e-05  Syn
2.85_0.475 2.85 0.4750  7.867521  <2e-16  Syn
2.85_0.95  2.85 0.9500 10.492628  <2e-16  Syn
2.85_1.425 2.85 1.4250  4.577642 0.00013  Syn
3.8_0.0095 3.80 0.0095  3.809688 0.00379  Syn
3.8_0.0285 3.80 0.0285  3.809688 0.00379  Syn
3.8_0.2375 3.80 0.2375  5.933555  <2e-16  Syn
3.8_0.475  3.80 0.4750  7.822571  <2e-16  Syn
3.8_0.95   3.80 0.9500  8.960655  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn  11   0    18

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
5.5514 [4.7906, 6.18]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower   upper call
1.9_0.95     6.6045 4.4249  8.7841  Syn
1.9_1.425   10.2930 2.6842 17.9018  Syn
2.85_0.475  13.3292 6.1146 20.5438  Syn
2.85_0.95   13.1710 7.9058 18.4361  Syn
2.85_1.425   9.4954 1.8632 17.1277  Syn
3.8_0.0095   7.7899 0.5259 15.0539  Syn
3.8_0.0285   7.7899 0.5259 15.0539  Syn
3.8_0.2375   7.2899 3.2980 11.2818  Syn
3.8_0.475    7.5611 4.2940 10.8282  Syn
3.8_0.95     7.6972 4.7761 10.6183  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  10   0    18
Figure 8: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Figure 9: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Figure 10: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos


Ceftazidime-avibactam + gentamicin (high inoculum)

Download data

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_gent_hinoc <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/kpcb_ceftazavi_gent_hinoc.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalhinoc <- fitMarginals(caz_gent_hinoc, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 5.0),
                            names = c("CTZ/AVI", "GENT"))
summary(marginalhinoc)
Formula: effect ~ fn(h1, h2, b = 5, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              3.588  4.541
Maximal response  24.000 24.000
log10(EC50)        2.170  1.518

Common baseline at: 5
Code
## Plotting marginal model for ceftazidime and gentamicin, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalhinoc) + ggtitle(paste("Ceftazidime/Avibactam + Gentamicin"))
rshinoc <- fitSurface(caz_gent_hinoc, marginalhinoc,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rshinoc)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 5, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              3.588  4.541
Maximal response  24.000 24.000
log10(EC50)        2.170  1.518

Common baseline at: 5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
4.988 [3.8144, 6.1365]
Evidence for effects in data: Syn 

Significant pointwise effects
      estimate  lower   upper call
40_20   7.4256 1.2730 13.5781  Syn
80_10   7.8653 0.4111 15.3196  Syn
80_20  12.3250 4.8002 19.8498  Syn
84_21   9.5696 1.0546 18.0846  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   4   0    12
Code
plot(rshinoc, legend = FALSE, main = "")
Figure 11: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 12: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos
Code
## mean R statistic evaluates how the test evaluates how the predicted response surface based on a specified null model differs from the observed one. If the null hypothesis is rejected, this test suggests that at least some dose combinations may exhibit synergistic or antagonistic behaviour. The meanR test is not designed to pinpoint which combinations produce these effects nor what type of deviating effect is present.



# maxR test allows to evaluate presence of synergistic/antagonistic effects for each dose combination and as such provides a point-by-point classification.


rshhinoc <- fitSurface(caz_gent_hinoc, marginalhinoc,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rshhinoc)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 5, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              3.588  4.541
Maximal response  24.000 24.000
log10(EC50)        2.170  1.518

Common baseline at: 5

Exact meanR test (H0 = no synergy/antagonism):
    F(12,48) = 40.1182 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
      d1 d2      absR p-value call
40_20 40 20  8.902446  <2e-16  Syn
40_40 40 40  3.162920 0.03215  Syn
42_21 42 21  3.424583 0.01508  Syn
80_10 80 10  4.762522 0.00012  Syn
80_20 80 20 15.822489  <2e-16  Syn
80_40 80 40  3.162920 0.03215  Syn
84_21 84 21  9.277699  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   7   0    12

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
5.3921 [4.9068, 6.2058]
Evidence for effects in data: Syn 

Significant pointwise effects
      estimate  lower   upper call
40_20   7.5826 3.4242 11.7410  Syn
80_10   7.9410 2.3937 13.4882  Syn
80_20  13.9276 9.6843 18.1710  Syn
84_21  11.4878 6.5496 16.4259  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   4   0    12
Code
rsbhinoc <- fitSurface(caz_gent_hinoc, marginalhinoc, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsbhinoc)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 5, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI   GENT
Slope              3.588  4.541
Maximal response  24.000 24.000
log10(EC50)        2.170  1.518

Common baseline at: 5

Exact meanR test (H0 = no synergy/antagonism):
    F(12,48) = 24.1709 (p-value = 0)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
      d1 d2      absR p-value call
40_20 40 20  6.910368  <2e-16  Syn
40_40 40 40  4.252764 0.00126  Syn
80_10 80 10  5.240497   1e-05  Syn
80_20 80 20 11.833922  <2e-16  Syn
84_21 84 21  5.455699   1e-05  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   5   0    12

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
4.988 [3.6842, 6.6536]
Evidence for effects in data: Syn 

Significant pointwise effects
      estimate  lower   upper call
40_20   7.4256 1.0353 13.8158  Syn
80_10   7.8653 0.7390 14.9916  Syn
80_20  12.3250 5.9078 18.7422  Syn
84_21   9.5696 2.1216 17.0176  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   4   0    12
Figure 13: Effect of combined ceftazidime/avibactam and gentamicin effects on Tpos

Ceftazidime/avibactam + aztreonam versus Catania strain

Download data

Results are shown in ?@fig-12cat.

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_azt <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/ndm_cazavi_azt.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFit3cat <- fitMarginals(caz_azt, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "AZT"))
summary(marginalFit3cat)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              4.446  5.970
Maximal response  24.000 24.000
log10(EC50)        2.733  2.843

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime/avibactam and aztroenam, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalFit3cat) + ggtitle(paste("Ceftazidime/Avibactam + Aztreonam"))
rs3cat <- fitSurface(caz_azt, marginalFit3cat,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs3cat)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              4.446  5.970
Maximal response  24.000 24.000
log10(EC50)        2.733  2.843

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
10.3364 [10.3082, 10.3485]
Evidence for effects in data: Syn 

Significant pointwise effects
             estimate   lower   upper call
19.95_1.197    2.0000  1.1506  2.8494  Syn
19.95_2.394    7.8025  6.9943  8.6107  Syn
19.95_3.99    14.5000 13.6645 15.3355  Syn
19.95_4.9875   9.9250  9.0978 10.7521  Syn
19.95_7.98    14.5000 13.6316 15.3684  Syn
19.95_9.975   14.5000 13.6415 15.3585  Syn
39.9_1.197     3.4999  2.6863  4.3134  Syn
39.9_19.95    12.3749 11.4706 13.2791  Syn
39.9_2.394     9.8813  9.0761 10.6865  Syn
39.9_3.99     14.4999 13.6689 15.3308  Syn
39.9_39.9     14.4999 13.5223 15.4774  Syn
39.9_4.9875   11.3429 10.5205 12.1653  Syn
39.9_7.98     14.4999 13.6364 15.3633  Syn
39.9_79.8     14.4998 13.4583 15.5414  Syn
39.9_9.975    14.4999 13.6435 15.3563  Syn
79.8_19.95    14.4971 13.5630 15.4312  Syn
79.8_39.9     14.4971 13.5204 15.4738  Syn
79.8_79.8     14.4970 13.4575 15.5365  Syn
9.975_1.197    2.2200  1.4120  3.0280  Syn
9.975_2.394    2.3300  1.4954  3.1646  Syn
9.975_4.9875   2.7000  1.8453  3.5547  Syn
9.975_9.975    3.8350  2.9557  4.7143  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    22
Code
plot(rs3cat, legend = FALSE, main = "")
Figure 14: Effect of combined ceftazidime/avibactam and aztreonam effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 15: Effect of combined ceftazidime/avibactam and aztreonam effects on Tpos
Code
rsh3cat <- fitSurface(caz_azt, marginalFit3cat,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh3cat)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              4.446  5.970
Maximal response  24.000 24.000
log10(EC50)        2.733  2.843

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(22,32) = 482.777 (p-value < 2e-16)

Evidence for effects in data: Ant
Points with significant deviations from the null: 
                 d1      d2      absR p-value call
19.95_1.197  19.950  1.1970 22.149569  <2e-16  Ant
19.95_2.394  19.950  2.3940 13.004736  <2e-16  Ant
19.95_3.99   19.950  3.9900 30.576846  <2e-16  Syn
19.95_4.9875 19.950  4.9875  4.306253 0.00311  Syn
19.95_7.98   19.950  7.9800 24.022524  <2e-16  Syn
19.95_9.975  19.950  9.9750 35.656311  <2e-16  Syn
39.9_1.197   39.900  1.1970 27.642378  <2e-16  Ant
39.9_19.95   39.900 19.9500  9.046079  <2e-16  Syn
39.9_3.99    39.900  3.9900 26.954813  <2e-16  Syn
39.9_39.9    39.900 39.9000 13.323312  <2e-16  Syn
39.9_4.9875  39.900  4.9875 11.550743  <2e-16  Syn
39.9_7.98    39.900  7.9800 21.270610  <2e-16  Syn
39.9_79.8    39.900 79.8000 10.385527  <2e-16  Syn
39.9_9.975   39.900  9.9750 27.811309  <2e-16  Syn
79.8_19.95   79.800 19.9500 11.793525  <2e-16  Syn
79.8_39.9    79.800 39.9000 10.465298  <2e-16  Syn
79.8_79.8    79.800 79.8000  7.699994  <2e-16  Syn
9.975_1.197   9.975  1.1970 35.692823  <2e-16  Ant
9.975_2.394   9.975  2.3940 29.602031  <2e-16  Ant
9.975_4.9875  9.975  4.9875 29.154426  <2e-16  Ant
9.975_9.975   9.975  9.9750 25.180733  <2e-16  Ant

Overall maxR summary:
 Call Syn Ant Total
  Ant  14   7    22

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
10.3364 [10.3117, 10.3473]
Evidence for effects in data: Syn 

Significant pointwise effects
             estimate   lower   upper call
19.95_1.197    2.0000  1.1029  2.8971  Syn
19.95_2.394    7.8025  6.9606  8.6443  Syn
19.95_3.99    14.5000 13.6351 15.3649  Syn
19.95_4.9875   9.9250  9.0743 10.7757  Syn
19.95_7.98    14.5000 13.6128 15.3872  Syn
19.95_9.975   14.5000 13.6314 15.3685  Syn
39.9_1.197     3.4999  2.6341  4.3656  Syn
39.9_19.95    12.3749 11.4695 13.2802  Syn
39.9_2.394     9.8813  9.0329 10.7297  Syn
39.9_3.99     14.4999 13.6300 15.3697  Syn
39.9_39.9     14.4999 13.5488 15.4510  Syn
39.9_4.9875   11.3429 10.4872 12.1986  Syn
39.9_7.98     14.4999 13.6080 15.3917  Syn
39.9_79.8     14.4999 13.5241 15.4756  Syn
39.9_9.975    14.4999 13.6229 15.3768  Syn
79.8_19.95    14.4971 13.5502 15.4439  Syn
79.8_39.9     14.4971 13.5404 15.4538  Syn
79.8_79.8     14.4971 13.5187 15.4755  Syn
9.975_1.197    2.2200  1.3765  3.0635  Syn
9.975_2.394    2.3300  1.4643  3.1957  Syn
9.975_4.9875   2.7000  1.8237  3.5763  Syn
9.975_9.975    3.8350  2.9482  4.7218  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    22
Code
rsb3cat <- fitSurface(caz_azt, marginalFit3cat,
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb3cat)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              4.446  5.970
Maximal response  24.000 24.000
log10(EC50)        2.733  2.843

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(22,32) = 508.0207 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
                 d1      d2      absR p-value call
19.95_1.197  19.950  1.1970 22.458782  <2e-16  Ant
19.95_2.394  19.950  2.3940 13.484443  <2e-16  Ant
19.95_3.99   19.950  3.9900 31.413435  <2e-16  Syn
19.95_4.9875 19.950  4.9875  6.427040  <2e-16  Syn
19.95_7.98   19.950  7.9800 25.801606  <2e-16  Syn
19.95_9.975  19.950  9.9750 39.153578  <2e-16  Syn
39.9_1.197   39.900  1.1970 29.991664  <2e-16  Ant
39.9_19.95   39.900 19.9500 10.930062  <2e-16  Syn
39.9_2.394   39.900  2.3940  3.743521 0.01539  Ant
39.9_3.99    39.900  3.9900 25.716968  <2e-16  Syn
39.9_39.9    39.900 39.9000 15.759285  <2e-16  Syn
39.9_4.9875  39.900  4.9875  9.341362  <2e-16  Syn
39.9_7.98    39.900  7.9800 21.454814  <2e-16  Syn
39.9_79.8    39.900 79.8000 15.453467  <2e-16  Syn
39.9_9.975   39.900  9.9750 28.423258  <2e-16  Syn
79.8_19.95   79.800 19.9500 11.013550  <2e-16  Syn
79.8_39.9    79.800 39.9000 10.771160  <2e-16  Syn
79.8_79.8    79.800 79.8000 10.468869  <2e-16  Syn
9.975_1.197   9.975  1.1970 35.970464  <2e-16  Ant
9.975_2.394   9.975  2.3940 28.871466  <2e-16  Ant
9.975_4.9875  9.975  4.9875 27.433089  <2e-16  Ant
9.975_9.975   9.975  9.9750 22.349685  <2e-16  Ant

Overall maxR summary:
 Call Syn Ant Total
  Syn  14   8    22

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
10.3364 [10.3151, 10.3434]
Evidence for effects in data: Syn 

Significant pointwise effects
             estimate   lower   upper call
19.95_1.197    2.0000  1.1659  2.8340  Syn
19.95_2.394    7.8025  7.0454  8.5596  Syn
19.95_3.99    14.5000 13.7191 15.2809  Syn
19.95_4.9875   9.9250  9.1649 10.6850  Syn
19.95_7.98    14.5000 13.6985 15.3015  Syn
19.95_9.975   14.5000 13.7252 15.2748  Syn
39.9_1.197     3.4999  2.7044  4.2953  Syn
39.9_19.95    12.3749 11.5603 13.1894  Syn
39.9_2.394     9.8813  9.1150 10.6476  Syn
39.9_3.99     14.4999 13.7118 15.2879  Syn
39.9_39.9     14.4999 13.6369 15.3628  Syn
39.9_4.9875   11.3429 10.5755 12.1102  Syn
39.9_7.98     14.4999 13.6915 15.3082  Syn
39.9_79.8     14.4998 13.6331 15.3666  Syn
39.9_9.975    14.4999 13.7132 15.2865  Syn
79.8_19.95    14.4971 13.6178 15.3763  Syn
79.8_39.9     14.4971 13.6140 15.3801  Syn
79.8_79.8     14.4970 13.6105 15.3835  Syn
9.975_1.197    2.2200  1.4525  2.9875  Syn
9.975_2.394    2.3300  1.5417  3.1183  Syn
9.975_4.9875   2.7000  1.9065  3.4935  Syn
9.975_9.975    3.8350  3.0366  4.6334  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    22
Figure 16: Effect of combined ceftazidime/avibactam and aztreonam effects on Tpos

Ceftazidime/avibactam + meropenem vs. Catania strain (MIC 16 mg/L)

Download data

Results are shown in ?@fig-cat2.

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_mero_cat <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/kp_kpc_catania_cazavi_mero.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFitcat2 <- fitMarginals(caz_mero_cat, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "AZT"))
summary(marginalFitcat2)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              9.482  2.472
Maximal response  24.000 24.000
log10(EC50)        2.636  1.651

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime/avibactam and aztroenam, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalFitcat2) + ggtitle(paste("Ceftazidime/Avibactam + Meropenem"))
rs3cat2 <- fitSurface(caz_mero_cat, marginalFitcat2,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs3cat2)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              9.482  2.472
Maximal response  24.000 24.000
log10(EC50)        2.636  1.651

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
2.9104 [0.4981, 4.2813]
Evidence for effects in data: Syn 

Significant pointwise effects
       estimate  lower   upper call
160_40   8.2526 3.9129 12.5923  Syn
80_40    5.9200 1.5803 10.2596  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   2   0    11
Code
plot(rs3cat2, legend = FALSE, main = "")
Figure 17: Effect of combined ceftazidime/avibactam and meropenem effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 18: Effect of combined ceftazidime/avibactam and meropenem effects on Tpos
Code
rsh3cat2 <- fitSurface(caz_mero_cat, marginalFitcat2,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh3cat2)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              9.482  2.472
Maximal response  24.000 24.000
log10(EC50)        2.636  1.651

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(11,40) = 20.429 (p-value = 0)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
        d1 d2      absR p-value call
160_20 160 20  5.212307   4e-05  Syn
160_40 160 40 10.785807  <2e-16  Syn
80_40   80 40  7.177069  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   3   0    11

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
2.9107 [-0.6493, 5.3431]
Evidence for effects in data: None 

Significant pointwise effects
       estimate  lower   upper call
160_40   8.2533 3.7737 12.7329  Syn
80_40    5.9200 1.4404 10.3995  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   2   0    11
Code
rsb3cat2 <- fitSurface(caz_mero_cat, marginalFitcat2, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb3cat2)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    AZT
Slope              9.482  2.472
Maximal response  24.000 24.000
log10(EC50)        2.636  1.651

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(11,40) = 21.4762 (p-value = 0)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
        d1 d2      absR p-value call
160_20 160 20  5.228880   3e-05  Syn
160_40 160 40 11.106088  <2e-16  Syn
80_40   80 40  7.497998  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   3   0    11

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
2.9104 [0.2068, 6.6625]
Evidence for effects in data: Syn 

Significant pointwise effects
       estimate  lower   upper call
160_40   8.2526 3.8138 12.6914  Syn
80_40    5.9200 1.4811 10.3588  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   2   0    11
Figure 19: Effect of combined ceftazidime/avibactam and meropenem effects on Tpos


Ceftazidime/avibactam + colistin

Download data

Results are shown in ?@fig-13wp2.

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_col <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/kpcb_colistin_cazavi.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFit4 <- fitMarginals(caz_col, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "COL"))
summary(marginalFit4)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    COL
Slope              9.277  5.406
Maximal response  24.000 24.000
log10(EC50)        0.307 -0.879

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime/avibactam and colistin, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalFit4) + ggtitle(paste("Ceftazidime/Avibactam + Colistin"))
rs4 <- fitSurface(caz_col, marginalFit4,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs4)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    COL
Slope              9.277  5.406
Maximal response  24.000 24.000
log10(EC50)        0.307 -0.879

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
1.9751 [1.0809, 3.1257]
Evidence for effects in data: Syn 

Significant pointwise effects
             estimate  lower   upper call
0.95_0.057     3.0903 0.5076  5.6730  Syn
0.95_0.11875   4.6662 0.1831  9.1493  Syn
1.9_0.057      5.0066 0.8011  9.2120  Syn
1.9_0.11875    6.0052 0.1669 11.8434  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   4   0    10
Code
plot(rs4, legend = FALSE, main = "")
Figure 20: Effect of combined ceftazidime/avibactam and colistin effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 21: Effect of combined ceftazidime/avibactam and colistin effects on Tpos
Code
rsh4 <- fitSurface(caz_col, marginalFit4,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh4)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    COL
Slope              9.277  5.406
Maximal response  24.000 24.000
log10(EC50)        0.307 -0.879

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(10,116) = 10.6972 (p-value = 0)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
               d1      d2     absR p-value call
0.95_0.057   0.95 0.05700 5.135618   1e-05  Syn
0.95_0.11875 0.95 0.11875 4.185532 0.00049  Syn
1.9_0.057    1.90 0.05700 4.834160   2e-05  Syn
1.9_0.11875  1.90 0.11875 6.282205  <2e-16  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   4   0    10

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
2.315 [1.4096, 3.1969]
Evidence for effects in data: Syn 

Significant pointwise effects
            estimate  lower   upper call
0.95_0.057    3.1029 0.0431  6.1627  Syn
1.9_0.057     5.1054 0.1468 10.0639  Syn
1.9_0.11875   9.2794 2.3581 16.2006  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   3   0    10
Code
rsb4 <- fitSurface(caz_col, marginalFit4, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb4)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    COL
Slope              9.277  5.406
Maximal response  24.000 24.000
log10(EC50)        0.307 -0.879

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(10,116) = 8.9424 (p-value = 0)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
               d1      d2     absR p-value call
0.95_0.057   0.95 0.05700 4.939011  <2e-16  Syn
0.95_0.11875 0.95 0.11875 4.706784   3e-05  Syn
1.9_0.057    1.90 0.05700 5.072593  <2e-16  Syn
1.9_0.11875  1.90 0.11875 4.099764 0.00076  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   4   0    10

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
1.9751 [0.9216, 3.4088]
Evidence for effects in data: Syn 

Significant pointwise effects
[1] estimate lower    upper    call    
<0 rows> (or 0-length row.names)

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   0   0    10
Figure 22: Effect of combined ceftazidime/avibactam and colistin effects on Tpos

Ceftazidime/avibactam + meropenem

Download data

Results are shown in ?@fig-14wp2.

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_mero <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/caz_avi_meropenem_kpcb.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
mfcaz_mero <- fitMarginals(caz_mero, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "MER"))
summary(mfcaz_mero)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    MER
Slope              9.273 26.309
Maximal response  24.000 24.000
log10(EC50)        1.930  1.629

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime/avibactam and meropenem, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(mfcaz_mero) + ggtitle(paste("Ceftazidime/Avibactam + Meropenem"))
rscaz_mero <- fitSurface(caz_mero, mfcaz_mero,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rscaz_mero)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    MER
Slope              9.273 26.309
Maximal response  24.000 24.000
log10(EC50)        1.930  1.629

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
11.5398 [11.1794, 11.7478]
Evidence for effects in data: Syn 

Significant pointwise effects
       estimate   lower   upper call
10_0.4   5.8300  4.5426  7.1174  Syn
10_1.2   9.2500  7.9626 10.5374  Syn
10_2.4  12.5000 10.6794 14.3206  Syn
10_5    13.8300 12.0094 15.6506  Syn
20_0.3   4.0000  2.1794  5.8206  Syn
20_0.4  14.5000 13.2126 15.7873  Syn
20_1.2  14.5000 13.2126 15.7873  Syn
20_10   14.5000 12.6794 16.3206  Syn
20_2.4  14.5000 12.6794 16.3206  Syn
20_20   14.5000 12.6794 16.3206  Syn
20_40   12.1159 10.2325 13.9994  Syn
20_5    14.0000 12.7126 15.2873  Syn
40_0.3  14.4869 12.6662 16.3077  Syn
40_0.4  14.4869 12.6662 16.3077  Syn
40_10   14.4869 12.6662 16.3077  Syn
40_20   14.4869 12.6662 16.3077  Syn
40_40   12.1050 10.2225 13.9875  Syn
40_5    14.4869 12.6662 16.3077  Syn
80_10    9.3049  7.4498 11.1601  Syn
80_20    9.3049  7.4498 11.1601  Syn
80_40    7.7750  5.9141  9.6359  Syn
80_5     9.3049  7.4498 11.1601  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    23
Code
plot(rscaz_mero, legend = FALSE, main = "")
Figure 23: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 24: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos
Code
rshcaz_mero <- fitSurface(caz_mero, mfcaz_mero,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rshcaz_mero)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    MER
Slope              9.273 26.309
Maximal response  24.000 24.000
log10(EC50)        1.930  1.629

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(23,125) = 45.3163 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
       d1   d2      absR p-value call
10_0.4 10  0.4  4.196115 0.00105  Syn
10_1.2 10  1.2  6.657646  <2e-16  Syn
10_2.4 10  2.4  6.361714  <2e-16  Syn
10_5   10  5.0  7.038601  <2e-16  Syn
20_0.4 20  0.4 10.435897  <2e-16  Syn
20_1.2 20  1.2 10.435897  <2e-16  Syn
20_10  20 10.0  7.379333  <2e-16  Syn
20_2.4 20  2.4  7.379333  <2e-16  Syn
20_20  20 20.0  7.379333  <2e-16  Syn
20_40  20 40.0  5.778604   1e-05  Syn
20_5   20  5.0 10.076024  <2e-16  Syn
40_0.3 40  0.3  7.350492  <2e-16  Syn
40_0.4 40  0.4  7.350492  <2e-16  Syn
40_10  40 10.0  7.350492  <2e-16  Syn
40_20  40 20.0  7.350492  <2e-16  Syn
40_40  40 40.0  5.778604   1e-05  Syn
40_5   40  5.0  7.350492  <2e-16  Syn
80_10  80 10.0  4.068120 0.00181  Syn
80_20  80 20.0  4.068120 0.00181  Syn
80_40  80 40.0  4.068120 0.00181  Syn
80_5   80  5.0  4.068120 0.00181  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn  21   0    23

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
11.6068 [11.0523, 11.9538]
Evidence for effects in data: Syn 

Significant pointwise effects
       estimate   lower   upper call
10_0.4   5.8300  4.5573  7.1027  Syn
10_1.2   9.2500  7.9773 10.5227  Syn
10_2.4  12.5000 10.7002 14.2998  Syn
10_5    13.8300 12.0302 15.6298  Syn
20_0.3   4.0000  2.2001  5.7998  Syn
20_0.4  14.5000 13.2273 15.7727  Syn
20_1.2  14.5000 13.2273 15.7727  Syn
20_10   14.5000 12.7001 16.2998  Syn
20_2.4  14.5000 12.7001 16.2998  Syn
20_20   14.5000 12.7001 16.2998  Syn
20_40   12.1159 10.2644 13.9675  Syn
20_5    14.0000 12.7273 15.2727  Syn
40_0.3  14.4869 12.6868 16.2870  Syn
40_0.4  14.4869 12.6868 16.2870  Syn
40_10   14.4869 12.6868 16.2870  Syn
40_20   14.4869 12.6868 16.2870  Syn
40_40   12.1159 10.2644 13.9675  Syn
40_5    14.4869 12.6868 16.2870  Syn
80_10    9.3049  7.4374 11.1725  Syn
80_20    9.3049  7.4374 11.1725  Syn
80_40    9.3049  7.4374 11.1725  Syn
80_5     9.3049  7.4374 11.1725  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    23
Code
rsb_caz_mero <- fitSurface(caz_mero, mfcaz_mero, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb_caz_mero)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    MER
Slope              9.273 26.309
Maximal response  24.000 24.000
log10(EC50)        1.930  1.629

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(23,125) = 45.3688 (p-value < 2e-16)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
       d1   d2      absR p-value call
10_0.4 10  0.4  4.196120 0.00109  Syn
10_1.2 10  1.2  6.657651  <2e-16  Syn
10_2.4 10  2.4  6.361717  <2e-16  Syn
10_5   10  5.0  7.038604  <2e-16  Syn
20_0.4 20  0.4 10.436234  <2e-16  Syn
20_1.2 20  1.2 10.436234  <2e-16  Syn
20_10  20 10.0  7.379539  <2e-16  Syn
20_2.4 20  2.4  7.379539  <2e-16  Syn
20_20  20 20.0  7.379538  <2e-16  Syn
20_40  20 40.0  5.746443  <2e-16  Syn
20_5   20  5.0 10.076361  <2e-16  Syn
40_0.3 40  0.3  7.364468  <2e-16  Syn
40_0.4 40  0.4  7.364468  <2e-16  Syn
40_10  40 10.0  7.364468  <2e-16  Syn
40_20  40 20.0  7.364467  <2e-16  Syn
40_40  40 40.0  5.734395  <2e-16  Syn
40_5   40  5.0  7.364468  <2e-16  Syn
80_10  80 10.0  4.321396 0.00063  Syn
80_20  80 20.0  4.321396 0.00063  Syn
80_40  80 40.0  3.347345 0.02431  Syn
80_5   80  5.0  4.321396 0.00063  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn  21   0    23

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
11.5398 [10.9505, 11.88]
Evidence for effects in data: Syn 

Significant pointwise effects
       estimate   lower   upper call
10_0.4   5.8300  4.4960  7.1640  Syn
10_1.2   9.2500  7.9160 10.5840  Syn
10_2.4  12.5000 10.6134 14.3866  Syn
10_5    13.8300 11.9434 15.7166  Syn
20_0.3   4.0000  2.1134  5.8866  Syn
20_0.4  14.5000 13.1660 15.8340  Syn
20_1.2  14.5000 13.1660 15.8340  Syn
20_10   14.5000 12.6134 16.3866  Syn
20_2.4  14.5000 12.6134 16.3866  Syn
20_20   14.5000 12.6134 16.3866  Syn
20_40   12.1159 10.1648 14.0670  Syn
20_5    14.0000 12.6660 15.3340  Syn
40_0.3  14.4869 12.6003 16.3736  Syn
40_0.4  14.4869 12.6003 16.3736  Syn
40_10   14.4869 12.6003 16.3736  Syn
40_20   14.4869 12.6003 16.3736  Syn
40_40   12.1050 10.1538 14.0562  Syn
40_5    14.4869 12.6003 16.3736  Syn
80_10    9.3049  7.3647 11.2452  Syn
80_20    9.3049  7.3647 11.2452  Syn
80_40    7.7750  5.8306  9.7195  Syn
80_5     9.3049  7.3647 11.2452  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
  22   0    23
Figure 25: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos

Ceftazidime/avibactam + tigecycline

Download data

Results are shown in ?@fig-15wp2

Code
library(BIGL)
library(knitr)
library(rgl)
library(ggplot2)
library(broom)
library(kableExtra)
set.seed(12345)
cutoff <- 0.95
caz_tig <- read.csv("~/Desktop/ACUTEWEBSITE/datasets_combo/kcb_cazavi_tig.csv")
## Fitting marginal models, maximal fixed at 24 hours, minimal at 9.5 hours
marginalFit6 <- fitMarginals(caz_tig, method = "optim",                 
                            fixed = c("m1" = 24, "m2" = 24, "b" = 9.5),
                            names = c("CTZ/AVI", "TIG"))
summary(marginalFit6)
Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    TIG
Slope             10.087  3.789
Maximal response  24.000 24.000
log10(EC50)        1.935  1.467

Common baseline at: 9.5
Code
## Plotting marginal model for ceftazidime/avibactam and tigecycline, minimum constrained at 9 hrs and maximum constrained at 24 hours
plot(marginalFit6) + ggtitle(paste("Ceftazidime/Avibactam + Tigecycline"))
rs6 <- fitSurface(caz_tig, marginalFit6,
                 null_model = "bliss",
                 B.CP = 50, statistic = "none", parallel = FALSE)
summary(rs6)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    TIG
Slope             10.087  3.789
Maximal response  24.000 24.000
log10(EC50)        1.935  1.467

Common baseline at: 9.5



No test statistics were computed.
CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
1.6626 [0.7233, 2.7338]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower  upper call
79.8_19.95   1.6400 0.4535 2.8265  Syn
79.8_9.975   2.3744 1.2413 3.5075  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   2   0     3
Code
plot(rs6, legend = FALSE, main = "")
Figure 26: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos
Code
view3d(0, -75)
rglwidget()
Figure 27: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos
Code
rsh6 <- fitSurface(caz_tig, marginalFit6,
                  null_model = "hsa",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsh6)
Null model: Highest Single Agent with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    TIG
Slope             10.087  3.789
Maximal response  24.000 24.000
log10(EC50)        1.935  1.467

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(3,75) = 4.8073 (p-value = 0.0041)

Evidence for effects in data: Syn
Points with significant deviations from the null: 
             d1    d2    absR p-value call
79.8_19.95 79.8 19.95 2.75595 0.02189  Syn

Overall maxR summary:
 Call Syn Ant Total
  Syn   1   0     3

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
2.704 [1.6392, 3.6561]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower  upper call
79.8_19.95   3.5137 2.1299 4.8976  Syn
79.8_39.9    2.0597 0.6517 3.4676  Syn
79.8_9.975   2.5387 1.1549 3.9226  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   3   0     3
Code
rsb6 <- fitSurface(caz_tig, marginalFit6, 
                  null_model = "bliss",
                  B.CP = 50, statistic = "both", parallel = FALSE)
summary(rsb6)
Null model: Bliss independence with shared maximal response
Variance assumption used: "equal"

Formula: effect ~ fn(h1, h2, b = 19/2, m1 = 24, m2 = 24, e1, e2, d1, d2)
Transformations: No

                 CTZ/AVI    TIG
Slope             10.087  3.789
Maximal response  24.000 24.000
log10(EC50)        1.935  1.467

Common baseline at: 9.5

Exact meanR test (H0 = no synergy/antagonism):
    F(3,75) = 1.8988 (p-value = 0.1371)
MaxR test did not detect any deviations from the null.

CONFIDENCE INTERVALS
Overall effect
Estimated mean departure from null response surface with 95% confidence interval:
1.6626 [0.6256, 2.5476]
Evidence for effects in data: Syn 

Significant pointwise effects
           estimate  lower  upper call
79.8_19.95   1.6400 0.3335 2.9466  Syn
79.8_9.975   2.3744 1.1403 3.6085  Syn

Pointwise 95% confidence intervals summary:
 Syn Ant Total
   2   0     3
Figure 28: Effect of combined ceftazidime/avibactam and tigecycline effects on Tpos

References