- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01737320
Duration of Antibiotics for the Treatment of Gram-negative Bacilli Bacteremia
Duration of Antibiotics for the Treatment of Gram-negative Bacilli Bacteremia - a Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients with gram-negative aerobic bacilli bacteremia, defined as growth of a single gram-negative microorganism in one or more blood cultures, associated with evidence of infection (hyper- or hypothermia, a localized infection, sepsis or septic shock).
- We will include patients receiving appropriate antibiotic treatment for 7 days and are afebrile / not hypothermic for the last 48 hours. Both community and hospital acquired gram-negative bacteremias will be included, regardless of antibiotic susceptibility patterns. We will allow the inclusion of patients receiving less than 7 days if clinically stable and discharge from hospital is considered. We will then recruit the patient before discharge, if stable at least for 48 hours before randomization.
We will include the following sources of bacteremia:
- Primary bacteremia / unknown source
- Urinary tract
- Abdominal
- Respiratory tract
- Central venous catheter(CVC), when the catheter was removed before randomization
- Skin and soft tissue, including surgical site infection
Exclusion Criteria:
Gram-negative bacteremia due to specific infections as detailed here:
- Endocarditis / endovascular infections
- Necrotizing fasciitis
- Osteomyelitis
- Abdominal abscesses and other unresolved abdominal sources requiring surgical intervention (e.g., cholecystitis)
- Central nervous system infections
- Empyema
- CVC- related or CVC-associated bloodstream infections when the catheter is retained. We will permit the inclusion of patients with retained CVCs in whom the source of the bacteremia is not the CVC.
- Polymicrobial growth in blood cultures involving gram-positive or anaerobes in addition to gram-negatives (defined as either growth of two or more different species of microorganisms in the same blood culture, or growth of different species in two or more separate blood cultures within the same episode (< 48 h) and with clinical or microbiological evidence of the same source).
Specific pathogens including:
- Salmonella spp.
- Brucella spp.
Immunosuppression, including:
- HIV infection
- Hematopoietic stem-cell transplantation
- Neutropenia on day of randomization or in the 48 hours prior to randomization. Patients with neutropenic fever at presentation that are afebrile and non-neutropenic in the 48 hours before randomization will be included.
- Clinical instability during the 48 hours before randomization, defined as mean blood pressure<60 mmHg despite adequate fluid resuscitation or vasopressors support.
- Repeated positive blood cultures for the same organism separated by at least 24 hours, regardless of antibiotic treatment. Patients with repeated isolates on the first 24 hours will be included.
- Uncontrolled focus of infection: e.g. an abscess that was not drained sufficiently; non-drained moderate to severe hydronephrosis in a patient with bacteremia of urinary source; deep seated intra-abdominal infections that were not drained properly.
- Fever > 38.0C measured at least twice in the 48 h prior to recruitment; or > 38.5C once during the 48 h; or hypothermia <35.5C measured once during the 48 h.
- Previous enrollment in this trial
- Concurrent participation in another clinical trial
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: short-course
antibiotic treatment stopped on day 7 if the patient has been afebrile for 48 hours and clinically stable.
Continued hospitalization will be left to the discretion of the treating physician.
Antibiotics will be restarted if fever recurs in at least 2 consecutive measurements above 38 or in cases of clinically or microbiologically documented infections.
|
On day 7 of appropriate intravenous or oral antibiotic treatment for the bacteremic episode (day 1 is the first day of appropriate antibiotic therapy), patients will be randomized to:
|
Active Comparator: accepted prolonged antibiotic treatment
antibiotic treatment continued for 14 days according to accepted hospital local guidelines. Duration of hospital stay will also be left to the discretion of the treating physician. Type of empiric antibiotic treatment and later, specific antibiotic treatment, will be chosen by the treating physicians in consultation with the infectious diseases unit. The decision on timing of switch to oral antibiotic therapy will also be left to the discretion of the treating physician. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
composite of the following
Time Frame: Until day 90 after randomization
|
The primary outcome is a composite of the following outcome measures
|
Until day 90 after randomization
|
All -cause mortality
Time Frame: Until day 90 after randomization
|
All- cause mortality
|
Until day 90 after randomization
|
Treatment Failure
Time Frame: Until day 90 after randomization
|
Failure including any of the following:
|
Until day 90 after randomization
|
Hospital re-admissions or extended hospitalization
Time Frame: Until day 90 after randomization
|
We will define re-admission as a new hospitalization for any cause occurring more than14 days from start of appropriate antibiotic treatment. Patients hospitalized after day 14 (were never discharged or 7-day regimen who were readmitted between days 7-14) will be counted as failures for this outcome. We will define re-admission as a new hospitalization for any cause occurring more than14 days from start of appropriate antibiotic treatment. Patients hospitalized after day 14 (were never discharged or 7-day regimen who were readmitted between days 7-14) will be counted as failures for this outcome. |
Until day 90 after randomization
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clostridium difficile associated diarrhea
Time Frame: Until day 30 after randomization
|
Clostridium difficile associated diarrhea
|
Until day 30 after randomization
|
Development of Antibiotic resistance
Time Frame: Until day 30 after randomization
|
Development of resistance, defined as clinical isolates resistant to antibiotics previously used in the bacteremia episode.
Surveillance sampling will not be conducted.
|
Until day 30 after randomization
|
Carriage of carbapenem resistant Klebsiella pneumonia.
Time Frame: Until day 30 after randomization
|
Carriage of carbapenem resistant Klebsiella pneumonia (screened routinely)
|
Until day 30 after randomization
|
Total in hospital days
Time Frame: Until day 90 after randomization.
|
Total in hospital days within 30 and 90 days
|
Until day 90 after randomization.
|
Total antibiotic days
Time Frame: Until day 30 after randomization
|
Total antibiotic days
|
Until day 30 after randomization
|
Adverse events
Time Frame: Until day 30 after randomization
|
|
Until day 30 after randomization
|
Infection caused by other than gram-negative bacteremia
Time Frame: Until day 90 after randomization
|
Development of either clinically or microbiologically documented infection other than gram-negative bacteremia.
We will use the 2008 CDC/NHSN surveillance definitions of health-care associated infections for bacterial infections
|
Until day 90 after randomization
|
Number of hospital re-admissions
Time Frame: Until day 90 after randomization
|
Number of hospital re-admissions until day 90
|
Until day 90 after randomization
|
Functional capacity and time to return to baseline activity
Time Frame: Until day 30 after randomization
|
Functional capacity and time to return to baseline activity
|
Until day 30 after randomization
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Dafna Yahav, MD, Rabin Medical Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 0258-12-RMC
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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