- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02018094
The Amputation Surgical Site Infection Trial (ASSIT) (ASSIT)
July 11, 2019 updated by: Hull University Teaching Hospitals NHS Trust
A Randomised Control Trial to Determine Whether a 5 Day Course of Antibiotics is More Clinically and Cost Effective Than a 24 Hour Prophylactic Course for the Prevention of Surgical Site Infection Following Lower Limb Amputation
- Lower limb amputations are performed usually as a last resort in patients with acute and chronic limb ischaemia (CLI) caused by vascular disease, poorly controlled diabetes or, infection.
- In the period 2003-2008 there were approximately 5,000 amputations per year in the UK.
- The Centre for Disease Control defines a Surgical Site Infection (SSI) as an infection within 30 days of an operation or up to one year if an implant is left in place and the infection is related to an operative procedure.
- Figures from the Surgical Site Infection Surveillance reported that the highest rate of surgical site infection was reported in association with lower limb amputation at 13.1%.
- There is a clear under-representation and the infection rate within our institution is approximately 25% which reflects the infection rate reported in a recent trial by Sadat et al (22.5%)
- Prevention of surgical site infections is of paramount importance to patients, healthcare providers and policy-makers, as they impact on morbidity and mortality and have significant time and cost implications.
- Currently there is NO CONSENSUS as to what the best practice is towards antibiotic administration in such patients. From a questionnaire-based audit we performed including vascular departments across the entire country, practice varies in both course duration (single dose → 5 days antibiotic course) as well as choice of antibiotics.
- The guideline at our institution suggests the 5-day course of antibiotic prophylaxis. The course duration varies depending on the clinical picture as well as microbiology results and recommendations.
- There are no randomised control trials that have investigated this aspect of patient care. We have set up one such trial and through it, we are looking to establish a standard practice which will hopefully be as beneficial as possible to the patient but also cost-effective for NHS.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
As above
Study Type
Interventional
Enrollment (Actual)
160
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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-
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Hull, United Kingdom, HU3 2JZ
- Hull Royal Infirmary
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Adults ≥18 yrs undergoing lower limb amputations who are able to consent to the trial.
- Able to understand the Patient Information Sheet and capable and willing to give informed consent and follow the protocol requirements (including attending all follow-up visits)
Exclusion Criteria:
- Allergies to chlorhexidine/ alcohol/ iodophors
- Inability to give informed consent
- Patients who are admitted to hospital with severe sepsis secondary to gas gangrene requiring multiple operations and admission to Intensive Care Unit.
- Aged under 18 years at the time of recruitment
- Use of investigational drug/device therapy within preceding 4 weeks that may interfere with this study.
- Toe amputations
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: 24 hour antibiotic course
24 hours of the stated antibiotics administered intravenously (Augmentin and metronidazole.
Teicoplanin and or gentamicin will be used if penicillin allergic and state of renal function)
|
Augmentin 1.2g IV three times daily for 24 hours.
If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.
Other Names:
Intra-operative skin preparation prior to incision to skin.
Other Names:
500mg IV three times daily for 24 hours.
If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course
Other Names:
Alcoholic Chlorhexidine skin pre-op preparation
Other Names:
Teicoplanin 400mg on induction.
If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days
|
Active Comparator: 5 day antibiotic Course
24 hours of IV antibiotics followed by 4 days of oral antibiotics (Augmentin and metronidazole.
Teicoplanin and or gentamicin will be used if penicillin allergic and state of renal function.
Clindamycin will be used as a an oral replacement for penicillin allergic patients)
|
Augmentin 1.2g IV three times daily for 24 hours.
If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.
Other Names:
Intra-operative skin preparation prior to incision to skin.
Other Names:
500mg IV three times daily for 24 hours.
If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course
Other Names:
Alcoholic Chlorhexidine skin pre-op preparation
Other Names:
Teicoplanin 400mg on induction.
If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days
Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy
|
Active Comparator: Iodine
Skin Preparation used pre-operatively: Alcoholic Povidone
|
Augmentin 1.2g IV three times daily for 24 hours.
If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.
Other Names:
Intra-operative skin preparation prior to incision to skin.
Other Names:
500mg IV three times daily for 24 hours.
If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course
Other Names:
Teicoplanin 400mg on induction.
If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days
Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy
|
Active Comparator: Chlorhexidine
Skin preparation to be used preoperatively: Alcoholic chlorhexidine
|
Augmentin 1.2g IV three times daily for 24 hours.
If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.
Other Names:
500mg IV three times daily for 24 hours.
If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course
Other Names:
Alcoholic Chlorhexidine skin pre-op preparation
Other Names:
Teicoplanin 400mg on induction.
If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days
Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Surgical Site Infection
Time Frame: 30 days
|
Primary objective: to establish the effect of 5 days of antibiotics versus a 24-hour prophylactic course on the incidence of surgical site infection (SSI) - total ASEPSIS score >21
|
30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Impact of different skin preparations on infection rates
Time Frame: 30 days
|
ASEPSIS Questionnaire score >21
|
30 days
|
Rate of re-intervention
Time Frame: 30 days
|
Types of re-intervention: angioplasty, bypass, debridement, revision to higher level amputation.
|
30 days
|
Mortality
Time Frame: 1 year
|
Mortality of a patient
|
1 year
|
Satisfactory healing rates
Time Frame: 3 months
|
Metric Measurement.
Asepsis score derived by HPA post-discharge questionnaire.
Clinical examination, quality of life, time to prosthesis also recorded.
|
3 months
|
Quality of life Questionnaire
Time Frame: 1 year
|
Assessed with Short form (SF)-12 questionnaire
|
1 year
|
Resource use
Time Frame: up to 3 months
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length of stay, return to surgery, number of visits to general practitioners, hospital visits, and prescription of antibiotics.
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up to 3 months
|
Rate of C. Diff., MSSA (Methicillin Sensitive Staphylococcus Aureus), MRSA (Methicillin Resistant Staphylococcus Aureus) infection
Time Frame: 30 days
|
Infection progress
|
30 days
|
Mobility
Time Frame: 1 year
|
Locomotor Capabilities index - 5
|
1 year
|
Pain Control
Time Frame: 1 year
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McGill Pain questionnaire
|
1 year
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 8, 2013
Primary Completion (Actual)
March 1, 2014
Study Completion (Actual)
January 2, 2017
Study Registration Dates
First Submitted
December 5, 2013
First Submitted That Met QC Criteria
December 16, 2013
First Posted (Estimate)
December 23, 2013
Study Record Updates
Last Update Posted (Actual)
July 15, 2019
Last Update Submitted That Met QC Criteria
July 11, 2019
Last Verified
July 1, 2019
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Postoperative Complications
- Disease Attributes
- Infections
- Communicable Diseases
- Wounds and Injuries
- Surgical Wound Infection
- Wound Infection
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents, Local
- Anti-Infective Agents
- Enzyme Inhibitors
- Trace Elements
- Micronutrients
- Anti-Bacterial Agents
- Protein Synthesis Inhibitors
- Antiprotozoal Agents
- Antiparasitic Agents
- beta-Lactamase Inhibitors
- Disinfectants
- Plasma Substitutes
- Blood Substitutes
- Metronidazole
- Iodine
- Clindamycin
- Chlorhexidine
- Povidone-Iodine
- Povidone
- Amoxicillin-Potassium Clavulanate Combination
- Teicoplanin
Other Study ID Numbers
- ASSIT Trial
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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