- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05684198
NPWT vs Primary Closure in SSI Prevention for Emergency Laparotomies for Peritonitis (PRISTINE)
Emergency Laparotomy for Peritonitis and Surgical Site Infection: Preventive Subcutaneous NPWT vs Primary Closure - a Randomized Health Services Study
Study Overview
Status
Intervention / Treatment
Detailed Description
Surgical site infection is a particularly common morbidity in contaminated surgeries leading to prolonged length of hospital stay, healing time, and a significant financial burden on healthcare systems.
Hence, the objective of PRISTINE trial is to compare the effectiveness of subcutaneous NPWT with PC for SSI prevention in patients who, due to wound contamination, are prone to infection. Moreover, with a further cost analysis, the investigators aim to evaluate the rationale for the implementation of routine preventive NPWT for laparotomy for diffuse peritonitis.
Patients qualified for an emergency laparotomy for peritonitis in University Clinical Centre (UCC) Division of Oncological, Endocrine and General Surgery will be identified. Prior to laparotomy, participants will be randomized in 1:1 ratio to subcutaneous NPWT or PC. The assigned intervention will be performed intraoperatively, after fascia closure.
All participants will receive an empirical antibiotic therapy regimen consisting of tazobactam/piperacillin or ciprofloxacin+ metronidazole. Participants will be followed-up postoperatively for one year.
In case of an SSI all participants, regardless of their initial allocation, will be treated according to the standard of care with prolonged NPWT and targeted antibiotic therapy.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Katarzyna M Polomska
- Phone Number: +48794037928
- Email: k.polomska@gumed.edu.pl
Study Contact Backup
- Name: Piotr Spychalski
- Phone Number: +48667843555
- Email: piotr.spychalski@gumed.edu.pl
Study Locations
-
-
Pomerania
-
Gdańsk, Pomerania, Poland, 80952
- Recruiting
- UCC Division of Oncological, Transplant and General Surgery
-
Contact:
- Katarzyna M Polomska
- Phone Number: +48794037928
- Email: k.polomska@gumed.edu.pl
-
Contact:
- Piotr Spychalski, PhD, MD
- Phone Number: +48667843555
- Email: piotr.spychalski@gumed.edu.pl
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- qualified for an emergency laparotomy for peritonitis
- gave written informed consent
Exclusion Criteria:
- qualified for open abdomen treatment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: subcutaneous NPWT
The peritoneum and fascia will be closed as in the PC arm.
Subsequently, patients will be treated with commercially available vacuum-assisted closure systems (provided by Smith&Nephew or Hartmann) according to the manufacturer's instructions.
Following fascia closure, the NPWT foam will be adjusted to the wound size to fill the wound cavity without causing excessive wound dehiscence.
Subsequently, the foam will be placed in the subcutaneous tissue.
The foam will not be fixated on the skin with sutures.
The wound will be sealed with adhesive film.
In case of air leak in problematic areas such as the navel or ostomy, ostomy paste will be used to create a tighter seal.
Continuous pressure of 120 mmHg will be applied.
On the 3rd day postop, the dressing will be removed and closure by secondary intention will be performed.
|
Following fascia closure, NPWT system will be inserted into subcutaneous tissue, continuous negative pressure of 120 mmHg will be applied.
Other Names:
|
No Intervention: primary closure
The peritoneum will be closed as a separate layer with a 2-0 multifilament absorbable suture.
Subsequently, the fascia will be closed with a continuous suture using absorbable monofilament 0 sutures.
Subcutaneous tissue will be rinsed twice with hypochlorite solution following peritoneal closure and fascial closure.
Interrupted subcutaneous closure will be performed with absorbable multifilament 2-0 sutures.
Following skin disinfection with an alcohol solution, the skin will be closed with non-absorbable monofilament 2-0 or 3-0 sutures using the interrupted mattress technique.
Conventional Cosmopor® sterile gauze dressings will be applied.
Unless the dressing material will be saturated, the dressing will remain unchanged until 3rd day post-op.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Effective wound closure by 30th day post-op
Time Frame: 30 days
|
definitive wound closure, not followed by secondary wound dehiscence
|
30 days
|
Time to end of surgical treatment of the wound
Time Frame: 1 year
|
Time of last out-patient visit ending the process of treating surgical wound
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Length of stay
Time Frame: 90 days
|
postoperative length of hospital stay
|
90 days
|
Time to heal
Time Frame: 120 days
|
time to full epithelialisation of the wound
|
120 days
|
Volume of wound drainage
Time Frame: 60 days
|
Volume of wound drainage collected in a NPWT or drainage collector
|
60 days
|
Time of secondary NPWT treatment
Time Frame: 60 days
|
Duration of NPWT therapy administered if SSI occured
|
60 days
|
Post-operative morbidity
Time Frame: 60 days
|
occurrence of adverse events and complications following surgery measured with Clavien-Dindo scale (grade I to V; grade I represents any deviation from the normal post-operative course not requiring surgical, endoscopic or radiological intervention and grade 5 represents patient's death)
|
60 days
|
SSI presence or absence
Time Frame: 30 days
|
Surgical Site Infection according to Centre for Disease Control (CDC) criteria: Infection occurring within the first 30 post-operative days with at least one of the following:
Due to the inability to implement CDC for wounds treated with NPWT, the investigators have included additional SSI criteria: the absolute necessity to prolong NPWT after 3rd day postop, an anergic wound morphology or slough. |
30 days
|
Pain level
Time Frame: 7 days
|
Pain measured with Visual Analogue Scale every 8h (subjective pain strength scale from 0 to 10; 0 represents no pain and 10 represents the worst pain)
|
7 days
|
Scar quality
Time Frame: 1 year
|
Measured with Vancouver Scar Scale (VSS).
This scale ranges from 0 (representing normal skin) to 13 (representing worst scar imaginable).
VSS provides the assessment of the following wound characteristics: pigmentation (0-2), vascularity (0-3), pliability (0-5), height (0-3).
|
1 year
|
Cost
Time Frame: 1 year
|
Cost of hospitalisation and outpatient visits
|
1 year
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Jaroslaw Kobiela, Prof., MUG Division of General Surgery
- Principal Investigator: Piotr Spychalski, MD PhD, MUG Division of General Surgery
- Principal Investigator: Katarzyna M Polomska, Medical University of Gdansk (MUG)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 420/1
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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 Infections
-
International Centre for Diarrhoeal Disease Research...Centers for Disease Control and PreventionNot yet recruitingMeasles | Rubella | Cholera | Typhoid
-
MJM BontenJanssen Research & Development, LLC; Innovative Medicines InitiativeCompletedE.Coli InfectionsUnited States, United Kingdom, Canada, France, Germany, Italy, Japan, Spain
-
University of PittsburghWithdrawn
-
PfizerCompletedGroup B Streptococcus InfectionsUnited States, South Africa, United Kingdom
-
GlaxoSmithKlineActive, not recruitingInfections, MeningococcalFinland, Poland, Spain, United Kingdom, Germany, South Africa, Dominican Republic, Israel, Honduras
-
PfizerCompletedInfections, MeningococcalAustralia, Canada, Czechia, Panama, South Africa, Turkey
-
GlaxoSmithKlineCompletedInfections, MeningococcalFinland
-
PfizerCompletedInfections, MeningococcalPhilippines
-
GlaxoSmithKlineCompletedInfections, MeningococcalUnited States, Finland, Poland
Clinical Trials on subcutaneous NPWT
-
Molnlycke Health Care ABCompletedEvaluation of Negative Pressure Wound Therapy in the Treatment of DFUs Incl. Post Amputation Wounds.Diabetes | Foot UlcersUnited Kingdom
-
LifeBridge HealthKinetic Concepts, Inc.CompletedWounds and InjuriesUnited States
-
Chulalongkorn UniversityCompleted
-
University of Texas Southwestern Medical CenterOsiris TherapeuticsCompletedDiabetic WoundUnited States
-
Karolinska University HospitalStockholm South General HospitalRecruitingPostoperative Surgical Site InfectionSweden
-
Larry LaveryCompletedUlcer | Partial-thickness BurnUnited States
-
Robert Jones and Agnes Hunt Orthopaedic and District...Smith & Nephew, Inc.Recruiting
-
ConvaTec Inc.TerminatedDiabetic Foot Ulcer | Venous Leg UlcerColombia
-
Molnlycke Health Care ABCompletedAcute Non Infected Wounds | Non Infected Post Surgical WoundsGermany
-
Maastricht University Medical CenterUnknown