- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02265445
Deescalating Carbapenems in Hospital Setting (CARBEPARGNE)
February 20, 2017 updated by: Assistance Publique - Hôpitaux de Paris
Deescalating Carbapenems in Hospital Setting: a Multicentre Randomized Controlled Study Comparing Carbapenem Continuation and Switch to Another Beta-lactam for the Treatment of Infections Due to ESBL-producing Enterobacteriaceae
The study aims to evaluate a deescalating therapeutic strategy (switch the carbapenem to another beta-lactam for which the isolated pathogen is susceptible) in patients with well-defined ESBL-PE infections (usual sites of infections and non severe infections).
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
Carbapenems are considered the antibiotics of choice for the treatment of infections due to expanded-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE).
Their use is readily increasing because of the pandemic of ESBL-PE.
However, the future of these drugs is challenged by the worldwide emergency of new resistance mechanisms in the same pathogens, particularly the carbapenemases.
This resistance makes these drugs inactive and gives no therapeutic options for patients.
Resistance to carbapenems is strongly associated with the use of these drugs, because of their large spectrum and strong impact on the host flora.
Consequently, the correct use of these drugs is an important public health objective.
In France, the CA-SFM (Committee on Antimicrobial of the French Society for Microbiology) has suggested alternative strategies with narrow spectrum beta-lactam for the treatment of ESBL-PE infections, including 3rd or 4th cephalosporins, cefoxitin and penicillins with beta-lactamase inhibitors.
A recent analysis including 6 prospective cohort studies of bloodstream infections due to ESBL-producing Escherichia coli did not find an excess of mortality or a longer length of hospital stay for patients receiving penicillin with beta-lactamase inhibitors, as compared to patients treated with carbapenems, after adjusting by confounding factors.
As patients receiving carbapenems seem to be more severely affected, the efficacy and safety of the alternative strategy remain unproved.
A randomized study is therefore needed to evaluate a deescalating therapeutic strategy (switch the carbapenem to another beta-lactam for which the isolated pathogen is susceptible) in patients with well-defined ESBL-PE infections (usual sites of infections and non severe infections).
The objectives of the present study are to demonstrate that the alternative strategy of deescalating therapy is not inferior to a strategy maintaining the carbapenem in terms of clinical cure, survival, lack of relapse and microbiological cure.
Study Type
Interventional
Enrollment (Actual)
6
Phase
- Phase 4
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:
- Age ≥ 18 years
- Hospitalization in conventional ward; (3) Receiving a curative treatment with a carbapenem for at least 24 hours and less than 3 days for a recent infection due to an ESBL-PE, either initially or secondary documented
- With a site of infection originating from the urinary, digestive or biliary tract
- Identification of an ESBL-PE for which susceptibility results (by the method of discs) have shown to be susceptible to more narrow spectrum beta-lactams (cephalosporins, b-lactamase inhibitors, monobactams)
- With sepsis signs and symptoms controlled after initiation of antibiotic therapy
- For a community-acquired or hospital-acquired infection.
Exclusion Criteria:
- Pregnancy or breastfeeding
- Neutropenia (PNN < 500/mm3)
- Hospitalization in intensive care unit or bone marrow transplant unit
- Documented polymicrobial infection
- Culture of an ESBL-PE susceptible to an orally active drug (such as fluoroquinolones, cotrimoxazole) and possible use of one of these drugs
- Need to treat a EBLSE infection(s) wtih more than drug other than carbapenems
- Need to maintain an association with an aminoglycoside
- Colonization without signs and symptoms of sepsis
- Sepsis signs and symptoms not controlled at the time of enrolment
- Known allergy to beta-lactams
- Failure to complete medical examination
- Absence of signed written consent.
- Patient without healthcare insurance (French social security, CMU or AME)
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: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Maintaining carbapenem therapy
Intravenous therapy, Maintaining carbapenem therapy
|
Intravenous therapy, Maintaining carbapenem therapy
|
Active Comparator: Deescalation therapy
Switch for a narrow spectrum beta-lactam active on the causative ESBL-PE.
Deescalation therapy
|
Intravenous therapy Switch for a narrow spectrum beta-lactam active on the causative ESBL-PE.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical response
Time Frame: 7 days after the end of therapy
|
The main outcome will be the favorable response defined by criteria adapted to site of infection including clinical cure with resolution of sepsis, survival, microbiological eradication either documented or suspected, and the absence of a new antibiotic course for the treatment of the same ESBL-PE) at day 7 after the end of therapy.
|
7 days after the end of therapy
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Vital status of patients
Time Frame: 60 days after the initiation of therapy
|
Vital status at day 60 after initiation therapy ; Relapse at day 60 following initiation of therapy
|
60 days after the initiation of therapy
|
absence of relapse of the infection due to the same ESBL-PE strain
Time Frame: 60 days after the initiation of therapy
|
Vital status at day 60 after initiation therapy ; Relapse at day 60 following initiation of therapy
|
60 days after the initiation of therapy
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Phillipe LESPRIT, MD, Assistance Publique - Hôpitaux de Paris
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
June 1, 2015
Primary Completion (Actual)
June 1, 2016
Study Completion (Actual)
June 1, 2016
Study Registration Dates
First Submitted
October 2, 2014
First Submitted That Met QC Criteria
October 15, 2014
First Posted (Estimate)
October 16, 2014
Study Record Updates
Last Update Posted (Actual)
February 23, 2017
Last Update Submitted That Met QC Criteria
February 20, 2017
Last Verified
February 1, 2017
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- P130949
- AOM 13063 (Other Grant/Funding Number: French ministry)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
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.
Clinical Trials on Urinary Infection
-
Gloucestershire Hospitals NHS Foundation TrustUnknownCatheter Infection | Urinary Tract Infection in Pregnancy | Urinary Tract Infection Following Delivery
-
Bactiguard ABRehab Station StockholmCompletedComplications; Catheter, Urinary Infection or InflammationSweden
-
University of ManitobaTerminatedComplicated Urinary InfectionCanada
-
Impatients N.V. trading as myTomorrowsInmunotek S.L.No longer availableUrinary Tract Infections | Bladder Infection | Recurrent Urinary Tract Infection | Urinary Tract Infection Bacterial | Chronic Urinary Tract InfectionCzechia, Denmark, Serbia, France, Germany, Turkey, Belgium, Finland, Luxembourg, Netherlands, Norway, Romania, Slovakia, Slovenia, Sweden
-
Mashhad University of Medical SciencesUnknownUrinary Tract Infection | Bacteriuria | Nosocomial InfectionIran, Islamic Republic of
-
Lawson Health Research InstituteUniversity of Western Ontario, CanadaCompletedUrinary Tract Infection | Recurrent Urinary Tract InfectionCanada
-
University Hospital, MontpellierRecruitingUrinary Retention | Urinary Infection | Chronic Kidney InfectionFrance
-
Hadassah Medical OrganizationUnknown
-
National Center for Complementary and Integrative...Office of Dietary Supplements (ODS)UnknownUrinary Tract InfectionCanada
-
National Institute of Allergy and Infectious Diseases...TerminatedUrinary Tract InfectionUnited States
Clinical Trials on Maintaining carbapenem therapy
-
University Hospital, BordeauxCompletedAlzheimer's Disease or Related DisorderFrance
-
VA Office of Research and DevelopmentRecruitingSubstance Use Disorder | Mental Health Disorder | HomelessnessUnited States
-
Sir Run Run Shaw HospitalUnknownKlebsiella Pneumoniae InfectionChina
-
The University of Texas Health Science Center at...CompletedType 2 Diabetes | Energy Supply; Deficiency | Glucose Metabolism Disorders (Including Diabetes Mellitus)United States
-
Wuhan Union Hospital, ChinaYichang Humanwell Pharmaceutical Co., Ltd., ChinaCompletedMechanically Ventilated PatientsChina
-
National Institute of Diabetes and Digestive and...CompletedObesity | OverweightUnited States
-
Chiang Mai UniversityCompletedAnti-Bacterial Agents
-
Lawson Health Research InstituteCompleted
-
Rennes University HospitalCompletedCardiopulmonary BypassFrance
-
National University of Medical Sciences, PakistanCompleted