Protocol update for the SABATO trial: a randomized controlled trial to assess early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection

Achim J Kaasch, Anna Rommerskirchen, Martin Hellmich, Gerd Fätkenheuer, Reinhild Prinz-Langenohl, Siegbert Rieg, Winfried V Kern, Harald Seifert, SABATO trial group, Achim J Kaasch, Anna Rommerskirchen, Martin Hellmich, Gerd Fätkenheuer, Reinhild Prinz-Langenohl, Siegbert Rieg, Winfried V Kern, Harald Seifert, SABATO trial group

Abstract

Background: SABATO (Staphylococcus aureus bacteremia antibiotic treatment options) is a randomized, parallel-group, clinical non-inferiority trial designed to examine the efficacy and safety of early oral switch therapy in low-risk Staphylococcus aureus infection. The original trial protocol was published in Trials (accessible at https://doi.org/10.1186/s13063-015-0973-x ). Here we describe final amendments to the study protocol and discuss the underlying rationale.

Methods/design: Three major changes were introduced into the study protocol: (1) the inclusion and exclusion criteria were refined so that patients with certain comorbidities (end-stage renal disease, severe liver disease) and uninfected foreign bodies (orthopedic prosthesis, pacemaker, implanted cardiac cardioverter-defibrillator) became eligible for enrollment under certain conditions; (2) the target sample size was decreased by choosing a conventional non-inferiority margin of 10% and converting the interim analysis (215 patients) into the final analysis; and (3) an additional follow-up visit after 30 days was introduced to allow for a closer follow-up of patients.

Conclusion: Changes to the study protocol were introduced to improve the enrollment and follow-up of patients. Furthermore, the decrease of the sample size will facilitate completion of the trial.

Trial registration: ClinicalTrials.gov, NCT01792804. Registered on 13 February 2013. German Clinical trials register, DRKS00004741. Registered on 4 October 2013, EudraCT 2013-000577-77.

Keywords: Antimicrobial; Bacteremia; Bloodstream infection; Intravenous; Oral switch therapy; Pragmatic trial; Randomized controlled trial; Staphylococcus aureus.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Nambiar K, Seifert H, Rieg S, Kern WV, Scarborough M, Gordon NC, et al. Survival following Staphylococcus aureus bloodstream infection. A prospective multinational cohort study assessing the impact of place of care. J Infect. 2018;77(6):516–25.
    1. Kaasch AJ, Fätkenheuer G, Prinz-Langenohl R, Paulus U, Hellmich M, Weiß V, et al. Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO). Study protocol for a randomized controlled trial. Trials. 2015;16:450. doi: 10.1186/s13063-015-0973-x.
    1. Szubert Alexander, Bailey Sarah Lou, Cooke Graham S., Peto Tim, Llewelyn Martin J., Edgeworth Jonathan D., Walker A. Sarah, Thwaites Guy E. Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: Observational analyses within the ARREST trial. Journal of Infection. 2019;79(4):332–340. doi: 10.1016/j.jinf.2019.08.001.
    1. Wiese L., Mejer N., Schønheyder H.C., Westh H., Jensen A.G., Larsen A.R., Skov R., Benfield T. A nationwide study of comorbidity and risk of reinfection after Staphylococcus aureus bacteraemia. Journal of Infection. 2013;67(3):199–205. doi: 10.1016/j.jinf.2013.04.018.
    1. Chaudry MS, Carlson N, Gislason GH, Kamper AL, Rix M, Fowler VG, Jr, et al. Risk of Infective endocarditis in patients with end stage renal disease. Clin J Am Soc Nephrol. 2017;12(11):1814–1822. doi: 10.2215/CJN.02320317.
    1. Kaasch AJ, Kern WV, Joost I, Hellmich M, Seifert H, Rieg S. Effect of clinically uninfected orthopedic implants and pacemakers/AICDs in low-risk Staphylococcus aureus bloodstream infection on crude mortality rate. A post hoc analysis of a large cohort study. Open Forum Infect Dis. 2019. 10.1093/ofid/ofz170.

Source: PubMed

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