HOspital NEtwork STudy - Preparation for a Randomized Evaluation of Anti-Pneumonia Strategies (HONEST-PREPS)

HONEST-PREPS: Hospital Network Study - Preparation for a Randomized Evaluation of Anti-Pneumonia Strategies

Hospital Acquired and Ventilator Associated Pneumonia (HAP/VAP) pose a significant burden to patients admitted to the Intensive Care Unit (ICU). Reported incidence ranges from 10-16% in all ICU patients (including HAP and VAP) and around 20-30% in ventilated patients (VAP). Patients with HAP/VAP have a high mortality rate. The estimated attributable mortality of VAP is 6-13%.

Randomized Controlled Trials (RCTs) are the gold standard for evaluating medical interventions, but are difficult to perform in this population. Several preventive and therapeutic treatment options are being developed that will require evaluation in phase-III trials. These trials are challenging due to the relatively low incidence of the outcome (e.g. HAP/VAP) or of the domain under study (e.g. specific antibiotic resistant infections) and the requirement of informed consent in critically ill patients. There is a need for a well-organized and well-trained international RCT network that enables efficient execution of a series of RCTs in this population.

The aim of the current study is to set up an infrastructure to prospectively enroll patients at risk of HAP/VAP in ICUs in several European countries. Site personnel will be trained to obtain a GCP (Good Clinical Practice) certification (if not already done), to timely identify and enroll patients at risk of HAP/VAP, to timely identify occurrence of HAP/VAP, collect informed consent forms, collect source data, enter data into a clinical database, and use a dedicated system to reply to queries. Site sample collection, processing, identifying the causative organism, and antibiotic susceptibility testing will be validated and adapted if required where possible. Where site infrastructure and regulations allow, the possibility of automated data collection of included participants will be explored to ensure sustainability of the future platform. Furthermore, collected data will be used to inform future diagnostic, preventive and therapeutic trials. E.g. they may support assumptions in sample size calculations and expected number of enrolled participants, they may help in prioritizing interventions, or they may be used in simulations of adaptive trials to optimize decision rules.

Study Overview

• Status: Completed
• Conditions: Hospital-acquired Pneumonia; Ventilator Associated Pneumonia

• Study Type: Observational
• Enrollment (Actual): 2165

Contacts and Locations

Study Locations

• Albania
  • Tirana, Albania
    • University Trauma Hospital
• Croatia
  • Rijeka, Croatia
    • Clinical Hospital Center Rijeka
  • Slavonski Brod, Croatia
    • General Hospital Dr Josip Bencevic Slavonski Brod
• Czechia
  • Kolín, Czechia
    • Regional Hospital Kolin
  • Praha, Czechia
    • University Hospital Kralovske Vinohrady
  • Praha, Czechia
    • University Hospital Motol
  • Praha, Czechia
    • General University Hospital Prague
• France
  • Limoges, France
    • CHU de LImoges
• Latvia
  • Liepāja, Latvia
    • Liepaja Regional Hospital
  • Riga, Latvia
    • Paul Stradins Clinical University hospital
• Romania
  • Bucharest, Romania
    • Elias University Emergency Hospital
  • Bucharest, Romania
    • Central Military Emergency University Hospital "Dr. Carol Davila "
• Serbia
  • Belgrade, Serbia
    • Clinical Center of Serbia
  • Kragujevac, Serbia
    • Clinical Center Kragujevac
  • Novi Sad, Serbia
    • Institute for Pulmonary Diseases of Vojvodina
  • Novi Sad, Serbia
    • Clinical Center of Vojvodina

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients admitted to an ICU at risk of bacterial HAP/VAP are eligible to participate in the study.

Description

Inclusion Criteria:

• Age >= 18 years

• At risk of acquiring bacterial HAP or VAP during ICU stay, defined as meeting all of the following criteria:

  • expected or documented hospital length of stay of more than 48 hours
  • admitted to the ICU

Exclusion Criteria:

• Death is deemed to be imminent or inevitable during this hospital admission AND one or more of the patient, substitute decision maker or attending physician are not committed to full active treatment

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine the quality and efficiency of a research platform for HAP/VAP in ICUs by measuring the timeliness of enrolling eligible patients.	Assess the proportion of screened, eligible patients at risk of developing HAP or VAP by being enrolled within 48 hours of ICU admission.	Through study completion, an average of 2 years
To determine the quality and efficiency of a research platform for HAP/VAP in ICUs by capturing bacterial HAP/VAP episodes.	Analyse the proportion of enrolled patients who develop HAP/VAP during the initial ICU admission and who are registered in the eCRF (electronic Case Report Form) within 24 hours after onset. Onset is defined as the time of X-ray showing an infiltrate confirming HAP/VAP for patients meeting HAP/VAP FDA criteria.	Through study completion, an average of 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To determine the incidence of HAP/VAP at the ICU.	-Incidence of HAP and VAP per 1,000 patient-days	From the date of enrolment through to the date of ICU discharge, an average of 11 days
To determine the implementation of infection prevention and control measures in routine ICU care for prevention of HAP/VAP.	-Implementation of ICU-level HAP/VAP infection prevention measures	From the date of enrolment through to the date of ICU discharge, an average of 11 days
To determine microbiological etiology of HAP/VAP at the ICU (1).	-Microbiological cure between 7 and 10 days after HAP/VAP onset (%). (Proportion of patients with positive HAP/VAP diagnosis with the resolution of the symptoms between day 7-10 after the onset)	Between days 7 and 10 after HAP/VAP onset
To determine microbiological etiology of HAP/VAP at the ICU (2).	-Distribution of bacterial pathogens (%). (Proportion of identified bacterial pathogens associated with HAP/VAP episode).	+/- 48 hours of HAP/VAP onset
To determine microbiological etiology of HAP/VAP at the ICU (3)	-Resistance profiles of bacterial pathogens (% resistant) (proportion of resistant bacterial pathogen associated with HAP/VAP episode).	+/- 48 hours of HAP/VAP onset
To determine management of HAP/VAP at the ICU (1)	-IMV (Invasive Mechanical Ventilation)-free-days up to 28 days after VAP onset (days).	From the date of enrolment through to the date of ICU discharge, on average of 6 days
To determine management of HAP/VAP at the ICU (2)	-Antibiotic consumption before and after HAP/VAP (type of antibiotic administered per patient).	From the date of enrolment through to the date of ICU discharge, on average of 11 days
To determine management of HAP/VAP at the ICU (3).	-Survival up to 90 days post HAP/VAP onset rate (%) (Proportion of patient's confirmed alive vs. dead in %)	90 days after HAP/VAP onset
To determine outcome of HAP/VAP at the ICU (1).	-ICU survival rate (%). (Proportion of patients discharged from ICU alive vs. patients with in-ICU death)	From the date of HAP/VAP onset through to the date of ICU discharge, on average of 11 days
To determine outcome of HAP/VAP at the ICU (2).	-Hospital survival rate (%). (Proportion of patients discharged from hospital alive vs. patients with in-hospital death)	From the date of HAP/VAP onset through to the date of hospital discharge, on average of 12 days
To determine outcome of HAP/VAP at the ICU (3).	-Length of ICU stay before and after HAP/VAP (number of days spent in ICU before and after HAP/VAP onset)	From the date of enrolment through to the date of ICU discharge, on average of 11 days
To determine outcome of HAP/VAP at the ICU (4).	-Length of hospital stay before and after HAP/VAP (number of days spent in hospital before and after HAP/VAP onset).	From the date of enrolment through to the date of hospital discharge, on average of 12 days

Collaborators and Investigators

• Sponsor: UMC Utrecht
• Collaborators: University Hospital, Geneva; Universiteit Antwerpen
• Investigators: Principal Investigator: Marc Bonten, MD, PhD, UMC Utrecht

Publications and helpful links

Helpful Links

• COMBACTE (COMbatting BACterial resistance in Europe) consortium website: HONEST-PREPS is WP2-4 (Work Package) of COMBACTE-NET

Study record dates

Study Major Dates

• Study Start (Actual): May 20, 2020
• Primary Completion (Actual): May 31, 2022
• Study Completion (Actual): January 12, 2023

Study Registration Dates

• First Submitted: July 20, 2021
• First Submitted That Met QC Criteria: September 28, 2021
• First Posted (Actual): September 29, 2021

Study Record Updates

• Last Update Posted (Actual): November 29, 2023
• Last Update Submitted That Met QC Criteria: November 28, 2023
• Last Verified: December 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Disease Attributes; Cross Infection; Iatrogenic Disease; Healthcare-Associated Pneumonia; Pneumonia; Pneumonia, Ventilator-Associated
• Other Study ID Numbers: HONEST-PREPS

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No