- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04178382
Effect of PCR-CRISPR/Cas12a on the Early Anti-infective Schemes in Patients With Open Air Pneumonia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
ICU patients have a high incidence of bacterial infection in the lower respiratory tract, mainly with severe pneumonia, often causing severe sepsis and septic shock, which is one of the main causes of death in patients. At present, the biggest difficulty faced by clinicians is the continuous increase of bacterial resistance rate and the increase of patient mortality due to the early inadequacy empirical anti-infective treatment. Studies have shown that patients with VAP(Ventilator Associated Pneumonia) have irrational drug use in the early stage, with a mortality rate of more than 50%. When the rate of appropriate drug use has dropped to 33%, while mechanical ventilation time and ICU hospitalization time have been significantly shortened. Therefore, identifying pathogenes as early as possible and shortening the time of empirical anti-infective treatment are very important for improving the prognosis of patients with severe pneumonia and reducing the incidence of bacterial resistance.
There are three traditional methods for detecting pathogenic microorganisms: 1. microbial culture method is the most traditional means of identifying pathogen. It is necessary to inoculate the patient's body fluid, blood, etc. in a suitable medium, incubate in a suitable incubator, and then pass the drug. Sensitivity tests determine the resistance of microorganisms, usually takes 3-7 days. For some specific types of pathogenic microorganisms or microorganisms with harsh growth conditions, there may be negative culture results. Therefore, the traditional culture methods have disadvantages such as poor timeliness, relatively high requirements, and low positive culture rate (30-40%). 2. time-of-flight mass spectrometry: the mass spectrometry technique is used to analyze and detect the protein components of the strain, and the characteristic peak spectrum is obtained. Compared with the bacterial map in the database, the bacteria can be judged by matching. The method can be shortened by about 6-8 hours compared with the conventional culture method, but since the detection of the colony needs to reach a certain amount, the specimen can not be directly detected after obtaining the specimen, and the preliminary microbial culture is required. Therefore, the detection time still takes 1-2 days or more, and there is also the disadvantage of low timeliness. In addition, it is necessary to compare the expansion and standardization of the database, and the inability to analyze the resistance of microorganisms is also the inadequacy of the detection technology. 3. High-throughput sequencing technology: With the rapid development of molecular biology in recent years, high-throughput sequencing technology is widely used in the early diagnosis of clinical microbiology, the principle is mainly through the connection of the universal linker to the fragmentation to be sequenced. Genomic DNA, which produces tens of millions of single-molecule polyclonal polymerase chain reaction arrays, then performs large-scale primer hybridization and enzyme extension reactions, and obtains complete DNA sequence information by computer analysis. However, this technology is difficult to effectively distinguish between pathogenic bacteria and background bacteria, technology and database to be standardized, detection time still takes about 2 days, can not obtain microbial resistance, expensive and other shortcomings At the office. In summary, the current time limit for targeted anti-infective treatment is stopped 2 days after the specimen is taken. Therefore, the search for new, pathogenic microbial detection technology that is faster, more accurate and more sensitive is a hotspot and a difficult point in the field of microbial and anti-infective research in recent years.
The PCR-CRISPR/Cas12a combination technology of alveolar lavage fluid developed by the College of Life Sciences of Nanjing University is based on PCR amplification and fluorescence signal detection twice to achieve the detection of the presence and absence of specific DNA sequences in the test sample. technology. The determination of the detection result of the clinical sample pathogen is based on the comparison of the fluorescence results of the PCR product of the sample DNAD with the fluorescence detection results of the positive control (PC) and the negative control (NC) as a standard. The specific recognition function of the CRISPR/Cas12a system relies on the specific guidance and binding of the crRNA to specific DNA, and the specificity of the crRNA is determined by detection of a positive control of a common pathogen by a single crRNA. The detection technology is highly specific and takes only 2-3 hours, which is a qualitative leap in the detection time compared to the conventional technology.
In order to verify the feasibility and accuracy of the technology, the Center and the Nanjing University of Life Sciences for the common pathogens of ICU pneumonia (Acinetobacter baumannii, MRSA, Klebsiella pneumoniae, Pseudomonas aeruginosa, etc.) for alveolar A preliminary study of the PCR-CRISPR/Cas12a combined detection technique for lavage fluid. Twenty-nine specimens of lower respiratory tract alveolar lavage fluid were cultured by conventional bacterial culture method and combined with PCR-CRISPR/Cas12a. The results showed that the accuracy of detection and identification of pathogens based on PCR-Cas12a technology reached 93.10% (27/29). For the 27 specimens, the pathogens infected by the traditional isolation culture method can be detected by PCR-CRISPR/Cas12a technology. The two exceptions were the detection of Acinetobacter baumannii in the No. 6 sample by the traditional isolation culture method and the detection of Proteus mirabilis in the No. 13 sample (not within the range of pathogens detected). Moreover, the pathogens identified by the PCR-CRISPR/Cas12a combination technique were more than one or two different than the traditional culture methods, which was consistent with the PCR, suggesting that the sensitivity is much higher than that of conventional microbial culture, and the results are reliable. These preliminary results indicate that the PCR-CRISPR/Cas12a combined detection technique has good accuracy and high sensitivity.
Based on those, the research team speculated that the combination of PCR and CRISPR/Cas12a detection technology of alveolar lavage fluid to guide anti-infective treatment of pneumonia patients can achieve targeted anti-infective treatment and improve patient prognosis. To validate the above hypothesis, we designed a multicenter randomized prospective study comparing the effects of PCR-CRISPR/Cas12a combined detection with alveolar lavage fluid and traditional microbial detection techniques on antimicrobial adjustment and prognosis in patients with ICU pneumonia. It aims to find more rapid, accurate and sensitive microbial detection technology for patients with pneumonia, and to achieve earlier precision treatment.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Jiangsu
-
Nanjing, Jiangsu, China, 210008
- Recruiting
- The Affliated Drum Tower Hospital, Medical School of Nanjing University
-
Contact:
- Wenkui Yu
- Phone Number: 60506 02568182222
- Email: yudrnj@163.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- age ≥ 18 years
- patients with artificial airway and expected artificial airway for more than 48 hours
- patients with suspected pneumonia or clear pneumonia
- signed informed consent
- expected ICU hospitalization more than 3 days.
Exclusion Criteria:
- pregnant women
- lactating women
- considered by the doctors for bronchoscopy moderate to severe asthma
- airway stenosis
- tracheal fistula, bronchopleural fistula
- expected to die or give up treatment within 72 hours
- participate in other clinical research
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: experiment group
Combined detection of PCR and CRISPR/Cas12a in alveolar lavage fluid to guide early target adjustment of antibiotics
|
Evaluate whether the combination of PCR and CRISPR/Cas12a detection of alveolar lavage fluid changes the choice of early antibiotics in patients with pneumonia in artificial airways, and whether it changes the prognosis compared with traditional pathogenic microbial detection techniques.
|
No Intervention: control group
Guide the target adjustment of antibiotics according to traditional microbiological detection methods
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
mortality
Time Frame: up to 28 days after hospitalized.
|
The patient's 28-day mortality rate is the survival rate from the onset to the disease at 28 days, compared with the total number of illnesses, to assess the severity of the disease.
|
up to 28 days after hospitalized.
|
the duration of intensive care unit
Time Frame: Up to 8 weeks
|
time for patients treatment in intensive care unit is patient total treated days in intensive care unit.
|
Up to 8 weeks
|
the length of hospital stay
Time Frame: Up to 8 weeks
|
time for patients treatment in hospital is patient total treated days in hosiptal.
Index of treat effective and severity of disease.
|
Up to 8 weeks
|
the day of mechanical ventilation
Time Frame: Up to 8 weeks
|
time for patients need mechanical ventilation is the total days that patient need mechanical ventilation.
|
Up to 8 weeks
|
the duration of septic shock
Time Frame: up to 8 weeks
|
The more severity patients had a long time during septic shock
|
up to 8 weeks
|
the incidence of antibiotic-associated diarrhea
Time Frame: up to 8 weeks
|
The incidence of antibiotic-associated diarrhea is the index of side effects of anti-infective treatment.
The time frame started after the use of antibiotics, during the total hospitalized.
|
up to 8 weeks
|
the incidence of new multi-drug resistant bacteria colonization or infection
Time Frame: up to 8 weeks.
|
rate of multi-drug resistant bacteria colonization or infection is the index of side effects of anti-infective treatment.
The time frame started after the use of antibiotics, during the total hospitalized.
|
up to 8 weeks.
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: kui w yu, phd, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
Publications and helpful links
General Publications
- Almirall J, Bolibar I, Vidal J, Sauca G, Coll P, Niklasson B, Bartolome M, Balanzo X. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J. 2000 Apr;15(4):757-63. doi: 10.1034/j.1399-3003.2000.15d21.x.
- Pletz MW, Wellinghausen N, Welte T. Will polymerase chain reaction (PCR)-based diagnostics improve outcome in septic patients? A clinical view. Intensive Care Med. 2011 Jul;37(7):1069-76. doi: 10.1007/s00134-011-2245-x. Epub 2011 May 15.
- Langelier C, Zinter MS, Kalantar K, Yanik GA, Christenson S, O'Donovan B, White C, Wilson M, Sapru A, Dvorak CC, Miller S, Chiu CY, DeRisi JL. Metagenomic Sequencing Detects Respiratory Pathogens in Hematopoietic Cellular Transplant Patients. Am J Respir Crit Care Med. 2018 Feb 15;197(4):524-528. doi: 10.1164/rccm.201706-1097LE. No abstract available.
- Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J Crit Care. 2008 Mar;23(1):91-100. doi: 10.1016/j.jcrc.2007.08.007.
- Wang Y, Liang X, Jiang Y, Dong D, Zhang C, Song T, Chen M, You Y, Liu H, Ge M, Dai H, Xi F, Zhou W, Chen JQ, Wang Q, Chen Q, Yu W. Novel fast pathogen diagnosis method for severe pneumonia patients in the intensive care unit: randomized clinical trial. Elife. 2022 Oct 7;11:e79014. doi: 10.7554/eLife.79014.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2019-195-01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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 Severe Sepsis
-
Indonesia UniversityCompletedSevere Sepsis With Septic Shock | Severe Sepsis Without Septic ShockIndonesia
-
Beckman Coulter, Inc.Biomedical Advanced Research and Development AuthorityRecruitingSevere Sepsis | Severe Sepsis Without Septic ShockUnited States
-
Rennes University HospitalUnknownSevere Sepsis or Septic Shock
-
Beckman Coulter, Inc.CompletedSepsis | Severe Sepsis | Severe InfectionFrance, Spain
-
Centre Hospitalier Universitaire de NiceUnknownComparison of Sensitivity Between Presepsine and Lactate for the Diagnosis of Severe Sepsis. (PREDI)Severe Sepsis and Septic ShockFrance
-
Yonsei UniversityCompletedSevere Sepsis or Septic ShockKorea, Republic of
-
University of RostockCompletedSevere Sepsis and Septic ShockGermany
-
Klinikum EmdenUniversitätsklinikum Hamburg-Eppendorf; Kantonsspital Baden; Kantonsspital MünsterlingenCompleted
-
University Hospital, Strasbourg, FranceUnknownSevere Sepsis and Septic ShockFrance
-
Peking Union Medical College HospitalUnknownLactate | Severe Sepsis With Septic Shock
Clinical Trials on PCR-CRISPR/Cas12a detection
-
Chinese Medical AssociationNot yet recruitingSevere PneumoniaChina
-
Children's Hospital of Fudan UniversityWithdrawnEnterovirus Infections
-
Kasr El Aini HospitalCompleted
-
Assistance Publique - Hôpitaux de ParisRecruiting
-
Huashan HospitalUnknown
-
ANRS, Emerging Infectious DiseasesEPISTEMCompleted
-
Bangladesh Medical Research Council (BMRC)UnknownHigh Sensitivity and Specificity (With 95% Confidence Interval) of RealDetect™ COVID-19 RT-PCR KitBangladesh
-
Assistance Publique - Hôpitaux de ParisCompletedDermatitis | Sezary Syndrome | Dermatitis, Exfoliative | Mycosis FungicidesFrance
-
Becton, Dickinson and CompanyWithdrawn
-
Erasmus Medical CenterGilead SciencesCompletedAspergillosis, Invasive PulmonaryNetherlands