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Daptomycin in the Treatment of Catheter-Related Staphylococcus Aureus

Primary Purpose

Staphylococcus Aureus

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Daptomycin
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Staphylococcus Aureus focused on measuring Catheter-Related Infection, Bloodstream Infections, Staphylococcus Aureus, Daptomycin

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or non-pregnant, non-lactating females with an age of greater than or equal to 18 years.
  2. The suspected culprit on exchangeable central venous catheter (CVC) is tunnel ( including implanted ports) or non-tunneled catheter, antibiotic or non-antibiotic coated catheter inserted in the subclavian, jugular or femoral vein.
  3. Patients must have at least two signs of sepsis from the list below, in any combination, within 48 hours prior to Daptomycin therapy and no other source for the bacteremia other than CVC: (a) Core temperature =/>38.0 degrees C or =/<36.0 degrees C, measured orally, rectally, tympanically or via a central catheter. If axillary add 0.5 degrees C to the measured temperature; (b) Pulse rate =/> 100 beats/min.; (c) Respiratory rate =/> 20/min; (d) white blood count (WBC) count =/>12,000/mm^3 or =/<4,000/mm^3 differential count showing >10% band forms; (e) Systolic blood pressure=/ <90 mm Hg
  4. Patients with suspected or definite diagnosis of uncomplicated CVC-related gram-positive bacteremia that includes at least one positive blood culture for S aureus. (If the positive blood culture is drawn through the CVC, then at least >15 colonies/ml will be required or the differential time of positive (DTP) of CVC at least 2 hours earlier than the peripheral culture)
  5. Signed informed consent
  6. No apparent source for the clinical manifestation of bacteremia other than the catheter

Exclusion Criteria:

  1. Creatinine clearance <30 mL/min at the time gram positive bacteremia was diagnosed unless the patient is on dialysis
  2. Bilirubin >4 times the upper limit of normal at the time gram positive bacteremia was diagnosed
  3. Treatment with an antibiotic effective against Gram-positive bacterial infections for more than 48 hours within 72 hours of study medication initiation, unless treatment failed.
  4. Documented S. aureus bacteremia within last 3 months due to source other than CVC.
  5. Patients who have participated in another investigational anti-infective study within 30 days
  6. History of hypersensitivity to lipopeptides
  7. Presence of additional source of infection with same organism cultured from blood, eg. endocarditis (as evidenced by vegetations on an echocardiogram), septic thrombosis
  8. Conditions with markedly decreased albumin in plasma (<1.5 g/dl), e.g., cirrhosis, nephritic syndrome, end-stage renal disease
  9. Anticipated prolonged therapy >4 weeks
  10. Prosthetic endovascular material
  11. Oliguria defined as urine output of <20 cc/hour averaged over 24 hours.
  12. Possible complicated CRBSI with persistent bacteremia for more than 48 hours on active antimicrobial therapy (such as osteomyelitis, endocarditis, and septic thrombosis.)
  13. Evidence of catheter site purulence as evidenced by purulent discharge.
  14. Patients with diagnosis of pneumonia that is related to S. aureus organism
  15. Patients taking concomitant "statins" (HMG-CoA reductase inhibitors)
  16. creatine phosphokinase (CPK) >10 times max-normal in asymptomatic patients and CPK >5 max-normal in symptomatic patients.

Sites / Locations

  • University of Texas MD Anderson Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Daptomycin

Arm Description

6mg/kg/day intravenous (IV) for 10 days

Outcomes

Primary Outcome Measures

Clinical Response Rate
Clinical response of Daptomycin administered for treatment of catheter-related bloodstream infections due to Staphylococcus Aureus bacteria, evaluated within 7 weeks of initiating Daptomycin therapy.

Secondary Outcome Measures

Full Information

First Posted
July 24, 2007
Last Updated
July 18, 2016
Sponsor
M.D. Anderson Cancer Center
Collaborators
Cubist Pharmaceuticals LLC
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1. Study Identification

Unique Protocol Identification Number
NCT00507247
Brief Title
Daptomycin in the Treatment of Catheter-Related Staphylococcus Aureus
Official Title
Phase II, Open-Label Study to Evaluate the Safety and Efficacy of Daptomycin in the Treatment of Catheter-Related Staphylococcus Aureus Bloodstream Infections
Study Type
Interventional

2. Study Status

Record Verification Date
November 2014
Overall Recruitment Status
Completed
Study Start Date
May 2006 (undefined)
Primary Completion Date
October 2007 (Actual)
Study Completion Date
September 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
Cubist Pharmaceuticals LLC

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Primary Objective: Evaluate the efficacy and safety of daptomycin given for treatment of catheter-related bloodstream infections due to S. aureus bacteria with or without exchange of the central venous catheter (CVC) over guide wire in comparison with a historical control group of catheter-related S. aureus bacteremia treated with standard therapy (Vancomycin) or other active agents against staph aureus (such as beta-lactam antibiotics).
Detailed Description
Daptomycin is a new antibiotic. It may be effective against a variety of bacterial infections that are difficult to treat. Aztreonam, Cefepime, Carbapenems and Augmentin are antibiotics that are used to treat certain types of bacteria. If you are found to be eligible to take part in this study, you will be given daptomycin by vein for at least 10 days, depending on your certain type of bacteria. You will receive Daptomycin by vein for 30 minutes every 24 hours. The CVC associated with CRBSI (catheter-related bloodstream infection = CR-BSI) from all enrolled patients will either be removed or be exchanged over guide wire for a new CVC within 96 hours of onset of the first blood culture. Your primary doctor will decide whether to remove or exchange the CVC with the willingness of you. If the study doctor and/or your primary physician knows or thinks that you have a mixed infection (both "gram positive" and "gram negative") or may have infection in lungs (pneumonia), you may also be treated with the antibiotic drugs Aztreonam, Cefepime, Carbapenems, or Augmentin by vein or by mouth in combination with the study drug Daptomycin. During each week of treatment, blood (about 1 tablespoon) will be drawn for routine lab tests. The blood sample may be drawn from the CVC, if the CVC is still in place. In addition, blood (about 1 tablespoon) will be drawn every other day until it no longer shows signs of infection. The catheter exit site may be examined at each visit until you have no more signs or symptoms of infection. If you are discharged from the hospital before completing the study medication, arrangements will be made to provide infusions on an out-patient basis or home infusion. During each week of treatment, you will be asked about any symptoms or illnesses that you have experienced. In addition, you will be asked to inform the study doctor and/or study staff of any medications or therapies that you are taking while on study. You will be taken off study if the infection gets worse or intolerable side effects occur. Participation on this study will last for a no more than 60 days. If you have been discharged from the hospital, the end of treatment visit will take place within 7 -14 days of the last day of study drug. You will need to return for the visit on an outpatient basis. At this visit, you will have a physical exam, including measurement of vital signs (heart rate, temperature, and blood pressure). Blood samples (about 1 tablespoon) will be drawn for routine test and to check for infection. The blood sample may be drawn from the CVC, if the CVC is still in place. The CVC exit site will be examined. You will be asked about any symptoms or illnesses that you may have experienced. In addition, you will be asked to inform the study doctor and/or study staff of any medications or therapies that you are taking. You will have a follow-up exam between 32 (+/- 7) days after your last dose of study drug. You will have a physical exam, including measurement of vital signs (heart rate, temperature, and blood pressure). Blood (about one tablespoon) will be drawn for routine tests and to check for infection. The blood samples may be drawn from the CVC, if the CVC is still in place. The CVC exit site may be examined. You will be asked about any symptoms or illnesses that you may have experienced. In addition, you will be asked to inform the study doctor and/or study staff of any medications or therapies that you are taking. Participation on this study will end once you complete the follow-up visit. This is an investigational study. Daptomycin is approved by the FDA for the treatment of skin and soft tissue infection. However, for the use described in this study and at this dose level, Daptomycin is authorized by the FDA for use in research only. About 50 patients will take part in this study. All will be enrolled at the University of Texas (UT) MD Anderson Cancer Center (MDACC).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Staphylococcus Aureus
Keywords
Catheter-Related Infection, Bloodstream Infections, Staphylococcus Aureus, Daptomycin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
11 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Daptomycin
Arm Type
Experimental
Arm Description
6mg/kg/day intravenous (IV) for 10 days
Intervention Type
Drug
Intervention Name(s)
Daptomycin
Other Intervention Name(s)
Cubicin
Intervention Description
6mg/kg/day IV for at least 10 days.
Primary Outcome Measure Information:
Title
Clinical Response Rate
Description
Clinical response of Daptomycin administered for treatment of catheter-related bloodstream infections due to Staphylococcus Aureus bacteria, evaluated within 7 weeks of initiating Daptomycin therapy.
Time Frame
7 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or non-pregnant, non-lactating females with an age of greater than or equal to 18 years. The suspected culprit on exchangeable central venous catheter (CVC) is tunnel ( including implanted ports) or non-tunneled catheter, antibiotic or non-antibiotic coated catheter inserted in the subclavian, jugular or femoral vein. Patients must have at least two signs of sepsis from the list below, in any combination, within 48 hours prior to Daptomycin therapy and no other source for the bacteremia other than CVC: (a) Core temperature =/>38.0 degrees C or =/<36.0 degrees C, measured orally, rectally, tympanically or via a central catheter. If axillary add 0.5 degrees C to the measured temperature; (b) Pulse rate =/> 100 beats/min.; (c) Respiratory rate =/> 20/min; (d) white blood count (WBC) count =/>12,000/mm^3 or =/<4,000/mm^3 differential count showing >10% band forms; (e) Systolic blood pressure=/ <90 mm Hg Patients with suspected or definite diagnosis of uncomplicated CVC-related gram-positive bacteremia that includes at least one positive blood culture for S aureus. (If the positive blood culture is drawn through the CVC, then at least >15 colonies/ml will be required or the differential time of positive (DTP) of CVC at least 2 hours earlier than the peripheral culture) Signed informed consent No apparent source for the clinical manifestation of bacteremia other than the catheter Exclusion Criteria: Creatinine clearance <30 mL/min at the time gram positive bacteremia was diagnosed unless the patient is on dialysis Bilirubin >4 times the upper limit of normal at the time gram positive bacteremia was diagnosed Treatment with an antibiotic effective against Gram-positive bacterial infections for more than 48 hours within 72 hours of study medication initiation, unless treatment failed. Documented S. aureus bacteremia within last 3 months due to source other than CVC. Patients who have participated in another investigational anti-infective study within 30 days History of hypersensitivity to lipopeptides Presence of additional source of infection with same organism cultured from blood, eg. endocarditis (as evidenced by vegetations on an echocardiogram), septic thrombosis Conditions with markedly decreased albumin in plasma (<1.5 g/dl), e.g., cirrhosis, nephritic syndrome, end-stage renal disease Anticipated prolonged therapy >4 weeks Prosthetic endovascular material Oliguria defined as urine output of <20 cc/hour averaged over 24 hours. Possible complicated CRBSI with persistent bacteremia for more than 48 hours on active antimicrobial therapy (such as osteomyelitis, endocarditis, and septic thrombosis.) Evidence of catheter site purulence as evidenced by purulent discharge. Patients with diagnosis of pneumonia that is related to S. aureus organism Patients taking concomitant "statins" (HMG-CoA reductase inhibitors) creatine phosphokinase (CPK) >10 times max-normal in asymptomatic patients and CPK >5 max-normal in symptomatic patients.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Issam Raad, MD
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.mdanderson.org
Description
University of Texas MD Anderson Cancer Center Website

Learn more about this trial

Daptomycin in the Treatment of Catheter-Related Staphylococcus Aureus

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