- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06067919
Assessment of the Applicability and Acceptability of an Algorithm to Guide the Prescription of 1st and 2nd Generation Cephalosporins as Part of Intraoperative Antibiotic Prophylaxis in Patients With a Declared Allergy to Penicillin (PROPHYLAL)
According to the Centers for Disease Control and Prevention (CDC), a surgical site infection (SSI) is an infection that occurs after surgery at the site where the surgery was performed. The prevalence of SSIs is difficult to obtain and is probably underestimated, as many SSIs occur after the patient has been discharged from hospital and are not taken into account. SSIs are responsible for an increase in length of stay, mortality and costs. Their prevention is therefore essential in the operating theater, and has been the subject of recommendations recently updated by the CDC. The first line of prevention is the administration of prophylaxis antibiotic adapted to the surgical procedure, administered within a specific timeframe in order to achieve an effective bactericidal concentration in the tissues at the time of the surgical incision. In France, in the United States and for the WHO, the recommended first line of antibiotic prophylaxis is most often an agent from the beta-lactam family, a penicillin or a cephalosporin, with the exception of ophthalmological surgery. No strategy is described for the management of patients with a reported allergy to penicillin, apart from the recommendation of therapeutic alternatives.
The use of a decision-making strategy in the operating theater for patients with a reported allergy to penicillin therefore appears necessary and is recommended by experts. In the intraoperative context, the application of a strategy would make it possible to guide the use of cephalosporins, without removing the "penicillin allergy" label from the patient, but by proposing an alternative via the use of a cephalosporin depending on the probability of the risk of a real allergy to penicillin, according to the description of the former reaction.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
According to the Centers for Disease Control and Prevention (CDC), a surgical site infection (SSI) is an infection that occurs after surgery at the site where the surgery was performed. The prevalence of SSIs is difficult to obtain and is probably underestimated, as many SSIs occur after the patient has been discharged from hospital and are not taken into account. SSIs are responsible for an increase in length of stay, mortality and costs. Their prevention is therefore essential in the operating theater, and has been the subject of recommendations recently updated by the CDC. The first line of prevention is the administration of prophylaxis antibiotic adapted to the surgical procedure, administered within a specific timeframe in order to achieve an effective bactericidal concentration in the tissues at the time of the surgical incision. In France, in the United States and for the WHO, the recommended first line of antibiotic prophylaxis is most often an agent from the beta-lactam family, a penicillin or a cephalosporin, with the exception of ophthalmological surgery. No strategy is described for the management of patients with a reported allergy to penicillin, apart from the recommendation of therapeutic alternatives.
The use of a decision-making strategy in the operating theater for patients with a reported allergy to penicillin therefore appears necessary and is recommended by experts. In the intraoperative context, the application of a strategy would make it possible to guide the use of cephalosporins, without removing the "penicillin allergy" label from the patient, but by proposing an alternative via the use of a cephalosporin depending on the probability of the risk of a real allergy to penicillin, according to the description of the former reaction.
The main objective is to assess the impact on first and second generation cephalosporins prescription rate of a decision tree designed to guide the prescription of first and second generation cephalosporins in patients with a self-reported allergy to penicillin.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Aurelie Gouel Cheron
- Phone Number: 33 140258355
- Email: aurelie.gouel@aphp.fr
Study Contact Backup
- Name: Philippe Montravers
- Phone Number: 33 140258355
- Email: philippe.montravers@aphp.fr
Study Locations
-
-
-
Paris, France
- Recruiting
- Bichat Hospital
-
Contact:
- Mouna Ben Rehouma
- Phone Number: 33 1 40 25 80 00
- Email: mouna.ben-rehouma@aphp.fr
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >= 18 years;
- Patients with a good French understanding
- Who declare themselves allergic to penicillin and who have not benefit from an allergy work-up to explore their allergies and possible therapeutic alternatives;
- Requiring antibiotic prophylaxis with either first or second generation cephalosporins for elective or emergency surgery.
Exclusion Criteria:
- Refusal to sign informed consent
- Patient under legal protection ;
- Pregnant women;
- Patient scheduled for surgery requiring first-line antibiotic prophylaxis with an agent other than first and second generation cephalosporins (such as amoxicillin/clavulanate or vancomycin) according to the recommendations of the French Society of Anaesthesia and Intensive Care (SFAR) in one of the investigating centres;
- Patient declaring an allergy to antibiotics other than penicillins.
- Not affiliated to a social security scheme
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: usual care
|
|
Experimental: use of a decision tree to guide antibiotic prophylaxis prescription
|
Presentation of a decision tree to anaesthetists to guide the choice of intraoperative antibiotic prophylaxis
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
prescription of 1st generation cephalosporins
Time Frame: surgery day
|
Rate of prescription of 1st cephalosporins for intraoperative antibiotic prophylaxis.
|
surgery day
|
prescription of 2nd generation cephalosporins
Time Frame: surgery day
|
Rate of prescription of 2nd generation cephalosporins for intraoperative antibiotic prophylaxis.
|
surgery day
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
surgical site infections (SSI)
Time Frame: 30 days after surgery
|
number of surgical site infections (SSI)
|
30 days after surgery
|
new surgery due to surgical site infections (SSI)
Time Frame: 30 days after surgery
|
number of new surgery due to SSI
|
30 days after surgery
|
intraoperative hypersensitivity reactions attributable to antibiotic prophylaxis
Time Frame: surgery day
|
Number of intraoperative hypersensitivity reactions attributable to antibiotic prophylaxis
|
surgery day
|
Collaborators and Investigators
Investigators
- Principal Investigator: Mouna Ben Rehouma, Assistance Publique - Hôpitaux de Paris
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- APHP220837
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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