- ICH GCP
- Amerikanska kliniska prövningsregistret
- Klinisk prövning NCT00795470
Factorial Trial of Antimicrobial Therapy and/or Catheter Change for Catheter Urinary Tract Infections. (CAUTION)
A Pilot Concealed Randomized Double-blinded Placebo-controlled Factorial Trial of Antimicrobial Therapy and/or Catheter Change for Catheter-associated Urinary Tract Infections in the Critically Ill
Urinary tract infection (UTI) is a common infection in patients in the intensive care unit (ICU) that increases length of stay but not mortality. It is not known whether antibiotic treatment will alter outcomes. Our previous studies have documented wide practice variations exist amongst doctors, including prescribing antibiotics to asymptomatic patients. Therefore, the merits of various ways to manage the infection require further studies to minimize the potential for over-prescribing of antibiotics, a practice that can increase the development of resistant bacteria.
The objective of this pilot study is to determine the feasibility of conducting a larger definitive study that will determine the effect of catheter change and/or systemic antibiotics as compared to no interventions on outcomes and resource utilization in ICU patients with UTI. Patients will be randomized to receive no treatment, antibiotics alone, urine catheter change alone, and both catheter change and antibiotics. Their clinical outcomes will be assessed.
Results from the pilot trial will provide information about whether it is feasible to conduct the larger definitive trial. Results of the definitive study will provide guidance to clinicians on how to manage a frequent clinical problem and optimize antibiotic usage.
Studieöversikt
Status
Betingelser
Intervention / Behandling
Studietyp
Fas
- Fas 3
Kontakter och platser
Studieorter
-
-
Ontario
-
Toronto, Ontario, Kanada, M5B1W8
- St. Michael's Hospital
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Adult ICU patient (≥ 18 years old)
- Admitted to the ICU for ≥ 96 hours
- Indwelling urinary catheter in place for ≥ 48hours that was inserted during this hospital admission
- Urine culture positive (≥ 105 CFU/mL) for 1 or 2 organism (s) (e.g. bacteria or fungus)
- Have received antimicrobial therapy that would cover the isolated organism(s) in the index urine culture for < 24 hours (i.e. therapy that does NOT cover the isolated organism(s) in the index urine culture of any duration or antimicrobial that covers the index urine organism for < 24 hours are permitted)
Exclusion Criteria:
- Suspected or confirmed pyelonephritis, renal abscess, or concurrent bacteremia with the same organism(s) as those isolated in the index urine culture
- Anuria (< 50 mL/day)
- Imminent death within 48 hours or decision to withdraw supportive care by clinical team
- Neutropenia (< 500/mm3)
- Patient has an alternative infection and requires an antimicrobial that has a spectrum of activity which include all the organism(s) isolated from the index urine culture
- Mixed fungal/bacterial CAUTI (i.e. index urine culture contains both bacteria and fungus)
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Faktoriell uppgift
- Maskning: Fyrdubbla
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
---|---|
Inget ingripande: No catheter change no antimicrobial
Urinary catheter will not be changed and no antimicrobials will be prescribed
|
|
Aktiv komparator: Antimicrobial and catheter change
|
Appropriate antimicrobial based on urine culture results
Change urine catheter
|
Aktiv komparator: Catheter change and NO antimicrobial
|
Change urine catheter
|
Aktiv komparator: Antimicrobial and NO catheter change
|
Appropriate antimicrobial based on urine culture results
|
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
---|---|---|
Number of patients enrolled
Tidsram: 18 months
|
none enrolled
|
18 months
|
Protocol Adherence Rate
Tidsram: 18 months
|
18 months
|
Sekundära resultatmått
Resultatmått |
Tidsram |
---|---|
ICU free days at Day 30
Tidsram: 30 days
|
30 days
|
Microbiologic Outcome
Tidsram: Day 7 and 14
|
Day 7 and 14
|
Developement of resistance
Tidsram: 14 days
|
14 days
|
Samarbetspartners och utredare
Sponsor
Samarbetspartners
Utredare
- Huvudutredare: Jan Friedrich, DPhil, MD, MSc, Unity Health Toronto
Publikationer och användbara länkar
Studieavstämningsdatum
Studera stora datum
Studiestart
Primärt slutförande (Faktisk)
Avslutad studie (Faktisk)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Uppskatta)
Uppdateringar av studier
Senaste uppdatering publicerad (Uppskatta)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- REB 08-287
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