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- Klinische proef NCT01894347
Prospective Observational Pilot-study for the Evaluation of the Nephro- an Neurotoxicity in the Anti-infectious Therapy With Inhalative Colistin Therapy for Patients With Ventilator-associated Pneumonia (VAP) (LOKALE)
Multi-Drug resistant pathogens (MDR) are reported worldwide with increasing incidence, especially in intensive care settings.
One of the drugs which are effective against MDRs, is colistin (polymyxin E). This agent has been reintroduced in response to the increase of MDR pathogens and might be used more often in the future. Data on safety regarding the most important side effects are not sufficiently available. l This study evaluates the toxicity in patients who receive aerosolized colistin.
Studie Overzicht
Toestand
Interventie / Behandeling
Gedetailleerde beschrijving
There is growing evidence that patients in the ICU setting have a special risk profile for consecutive colonization and possible infection due to MDR pathogens.
One therapy option is the use of inhalative colistin, as this agent has been demonstrated to be effective against these pathogens. Data on pharmacodynamics or - kinetics are transferred from older studies or from other patient populations. For patients with pulmonary colonization or infection due to an MDR pathogen the systemic resorption of the drug is not known, consequently systemic side effects including kidney or neural damage are not predictable.
This study focus on patients with inhalative colistin therapy and uses therapeutic drug monitoring to determine the rate of systemic resorption of colistin. For the evaluation of neurotoxicity function of peripheral nerves (neve conduction velocity) and of the eighth cranial nerve is monitored. Nephrotoxicity is estimated by creatinine level (-clearance) and the RIFLE criteria.
Studietype
Inschrijving (Werkelijk)
Contacten en locaties
Studie Locaties
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Berlin, Duitsland, 13353
- Charité Universitätsmedizin Charité
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion criteria:
- invasive ventilated patients (male and female) with assumed or assured bacteria with an elevated resistance pattern found in a tracheal or bronchial secretion with or without clinical signs of infection
- indicated colistin co-therapy or eradication-attempt with inhalative colistin (β-Lactam) therapy according to the standard operation procedure (SOP) of the hospital
Exclusion criteria:
- Consent of the patient or of the patient´s legal representative can´t be obtained soon
- Age < 18 years
- Included within another, prospective clinical antibiotics-study
- Hypersensitivity to colistin or polymyxin B
- Patients with cystic fibrosis
- Present letter of attorney or patient´s provision, which precludes a priori the participation in studies
- Missing consent for storage of pseudonymised data in context of the study
- The patient is in an institution due to a court injunction or administrative order
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
Interventie / Behandeling |
|---|---|
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Colistin inhalative
Adult ICU patients with
Patients included into the study group receive additional TDM, Monitoring of Neuro-and Nephropathology |
Therapeutic drug monitoring of serum levels and Monitoring of Neuro- and Nephropathology
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Number and frequency of adverse events (nephro- or neurotoxicity after aerosolised colistin therapy)
Tijdsspanne: 28 days
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Adverse events are measured based on validated criteria:
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28 days
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Serum concentration of colistin and β-Lactam antibiotics
Tijdsspanne: 3 days
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Colistin-concentration in serum following inhalative therapy (in mg/L) 2 hours and 8 hours of application and in steady state on day 3 of therapy
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3 days
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Serum levels of colistin and β-Lactam antibiotics (e.g. Meropenem)in mg/L
Tijdsspanne: 3 days
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Serum drug levels in mg/L 2hours, 8 hours and 3 days (steady state) after therapy induction
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3 days
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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Maria Deja, Prof., Charité Universititaetsmedizin Berlin
Publicaties en nuttige links
Algemene publicaties
- Falagas ME, Siempos II, Rafailidis PI, Korbila IP, Ioannidou E, Michalopoulos A. Inhaled colistin as monotherapy for multidrug-resistant gram (-) nosocomial pneumonia: a case series. Respir Med. 2009 May;103(5):707-13. doi: 10.1016/j.rmed.2008.11.018. Epub 2008 Dec 31.
- Falagas ME, Rafailidis PI. Nephrotoxicity of colistin: new insight into an old antibiotic. Clin Infect Dis. 2009 Jun 15;48(12):1729-31. doi: 10.1086/599226. No abstract available.
- Michalopoulos AS, Karatza DC. Multidrug-resistant Gram-negative infections: the use of colistin. Expert Rev Anti Infect Ther. 2010 Sep;8(9):1009-17. doi: 10.1586/eri.10.88.
- Hamer DH. Treatment of nosocomial pneumonia and tracheobronchitis caused by multidrug-resistant Pseudomonas aeruginosa with aerosolized colistin. Am J Respir Crit Care Med. 2000 Jul;162(1):328-30. doi: 10.1164/ajrccm.162.1.9910071.
Studie record data
Bestudeer belangrijke data
Studie start
Primaire voltooiing (Werkelijk)
Studie voltooiing (Werkelijk)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
Eerst geplaatst (Schatting)
Updates van studierecords
Laatste update geplaatst (Schatting)
Laatste update ingediend die voldeed aan QC-criteria
Laatst geverifieerd
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Chemisch veroorzaakte aandoeningen
- Pathologische processen
- Ziekten van het zenuwstelsel
- Infecties
- Luchtweginfecties
- Ziekten van de luchtwegen
- Longziekten
- Ziekte attributen
- Kruis infectie
- Iatrogene ziekte
- Vergiftiging
- Zorggerelateerde longontsteking
- Longontsteking
- Neurotoxiciteitssyndromen
- Longontsteking, ventilator-geassocieerd
Andere studie-ID-nummers
- LOKALE
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