search
Back to results

Optimizing Antibiotic Dosing Regimens for the Treatment of Infection Caused by Carbapenem Resistant Enterobacteriaceae

Primary Purpose

Drug Resistance, Carbapenem-Resistant Enterobacteriaceae Infection, Sepsis

Status
Unknown status
Phase
Not Applicable
Locations
Thailand
Study Type
Interventional
Intervention
Combined antibiotic regimens
Standard antibiotic regimens
Sponsored by
Phramongkutklao College of Medicine and Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Drug Resistance focused on measuring Pharmacokinetics/Pharmacodynamics, Antibiotic combination regimens, Dose-optimization, Carbapenem-Resistant Enterobacteriaceae Infection

Eligibility Criteria

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

Inclusion Criteria:

  1. Any patients are diagnosed any diseases caused by CRE infection by physicians at Phramongkutklao hospital during 1/4/2018 to 30/4/2021.
  2. Any patients are more than 18 years old.
  3. Any patients have at least 1 criterion as following 3.1 Any patients have at least 2 of the signs and symptoms of Systemic inflammatory response syndrome (SIRS), including

    • Fever (temperature > 38 °C) or hypothermia (temperature < 36°C)
    • Tachypnea (heart rate > 90 beats per minute)
    • Respiratory rate > 20 beats per minute or Paco2 < 32 mm Hg (4.3 kPa)
    • White blood cell count > 12,000 cells per millilitre (leukocytosis) or < 4,000 cells per milliliter (leukopenia) 3.2. Any patients are diagnosed with sepsis or have ≥ 2 points of Sequential Organ Failure Assessment (SOFA) Score or qSOFA (Quick SOFA) Score.

3.3. Any patients are diagnosed with septic shock or are received vasopressors (eg, dopamine, norepinephrine, epinephrine, vasopressin, phenylephrine), mean arterial pressure (MAP) < 65 mm Hg, and lactate > 2 mmol/L (18 mg/dL) 3.4 Any patients are received mechanical ventilation 3.5 Any patients are admitted at ICU ward.

Exclusion Criteria:

  1. Patients are breast-feeding or pregnancy.
  2. Patients are insufficient or incomplete information on the medical electronic record such as patients transferred.

Sites / Locations

  • Phramongkutklao hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Optimal antibiotic combination regimens

Standard antibiotic regimens

Arm Description

The patients in the groups will be given the optimal antibiotic combination regimens.

The patients in the groups will be given the standard antibiotic regimens.

Outcomes

Primary Outcome Measures

Clinical improvement or failure
Clinical improvement was defined as resolution of the signs and symptoms of the infection with no change or addition antibiotic therapy at the end of treatment course, excepting de-escalation to a narrower spectrum antibiotic. Clinical failure was defined as the signs and symptoms of the infection being more serious with change or addition antibiotic therapy against CRE.

Secondary Outcome Measures

Mortality
All cause mortality
Length of stay
The duration of a hospitalization
Physician acceptance rates
The rates of physicians' acceptance of an recommended optimal regimen
Microbiological outcomes
Bacterial response in cultures after the treatment

Full Information

First Posted
July 20, 2020
Last Updated
August 22, 2020
Sponsor
Phramongkutklao College of Medicine and Hospital
search

1. Study Identification

Unique Protocol Identification Number
NCT04516395
Brief Title
Optimizing Antibiotic Dosing Regimens for the Treatment of Infection Caused by Carbapenem Resistant Enterobacteriaceae
Official Title
Optimizing Antibiotic Dosing Regimens for the Treatment of Infection Caused by Carbapenem Resistant Enterobacteriaceae: the Study of in Vitro Activity of Monotherapy and Combination Therapy, PK/PD Study and Treatment Outcomes
Study Type
Interventional

2. Study Status

Record Verification Date
August 2020
Overall Recruitment Status
Unknown status
Study Start Date
September 2020 (Anticipated)
Primary Completion Date
March 2021 (Anticipated)
Study Completion Date
April 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Phramongkutklao College of Medicine and Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
The purpose of this study is to evaluate the treatment outcomes in patients with CRE infections.
Detailed Description
Antibiotic resistance is one of the major problems because of global burden. Resistant pathogens are non-susceptible to available antibiotics, causing of high clinical mortality (clinical impact) and high budget (economic impact), whereas new antibiotics in drug development are fewer. Carbapenem-Resistant Enterobacteriaceae (CRE) are categorized into one of the critical groups in World Health Organization's lists. In Thailand, the spread of CRE have been risen continuously since 2011. Diverse actions are designed to address antibiotic resistance with limited resources, known as antimicrobial stewardship programs (ASPs). Dose-optimization by using PK/PD (Pharmacokinetics/Pharmacodynamics) application is recommendation of supplemental strategies in clinical routine practice. The benefit of the strategy is to reduce inappropriate antibiotic use and provide minimum resistance as well as maximum the success of clinical treatment. Antibiotic combination regimens have a role for the CRE treatment. However, current evidence in clinical study is not concluded which the best or optimal combined antibiotics are. The reasons may be that combined antibiotics often vary among different sites of infection, causative pathogens, the patterns of local antimicrobial susceptibility and patient comorbidity. As the results, the antibiotic combination regimens for the treatment any infections caused by CRE is needed for further investigation. The anticipated result is to fill the limited data of the appropriate antibiotic regimens for individual Thai patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Drug Resistance, Carbapenem-Resistant Enterobacteriaceae Infection, Sepsis, Septic Shock, Critical Illness, Clinical Outcomes, Treatment Outcomes
Keywords
Pharmacokinetics/Pharmacodynamics, Antibiotic combination regimens, Dose-optimization, Carbapenem-Resistant Enterobacteriaceae Infection

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
According to the model, it divided into two parts - retrospective chart review and prospective data collection. Single independent patient group will be divided two parts depending on over a period of time. The patients in the retrospective part received a standard treatment become a control group, while the patients in the prospective part received the intervention become an experimental group.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
102 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Optimal antibiotic combination regimens
Arm Type
Experimental
Arm Description
The patients in the groups will be given the optimal antibiotic combination regimens.
Arm Title
Standard antibiotic regimens
Arm Type
Other
Arm Description
The patients in the groups will be given the standard antibiotic regimens.
Intervention Type
Other
Intervention Name(s)
Combined antibiotic regimens
Intervention Description
Combined antibiotic combinations defined as the optimal antibiotic combination regimens which are created from in vitro study and the application of PK/PD.
Intervention Type
Other
Intervention Name(s)
Standard antibiotic regimens
Intervention Description
Standard antibiotic regimens defined as the antibiotic regimens which are generally given to the patients following to the hospital protocol.
Primary Outcome Measure Information:
Title
Clinical improvement or failure
Description
Clinical improvement was defined as resolution of the signs and symptoms of the infection with no change or addition antibiotic therapy at the end of treatment course, excepting de-escalation to a narrower spectrum antibiotic. Clinical failure was defined as the signs and symptoms of the infection being more serious with change or addition antibiotic therapy against CRE.
Time Frame
up to 8 weeks
Secondary Outcome Measure Information:
Title
Mortality
Description
All cause mortality
Time Frame
Within 14 and 28/30 days after discharge
Title
Length of stay
Description
The duration of a hospitalization
Time Frame
up to 12 weeks
Title
Physician acceptance rates
Description
The rates of physicians' acceptance of an recommended optimal regimen
Time Frame
up to 72 hours after reporting the bacterial culture results
Title
Microbiological outcomes
Description
Bacterial response in cultures after the treatment
Time Frame
Before discharge

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Any patients are diagnosed any diseases caused by CRE infection by physicians at Phramongkutklao hospital during 1/4/2018 to 30/4/2021. Any patients are more than 18 years old. Any patients have at least 1 criterion as following 3.1 Any patients have at least 2 of the signs and symptoms of Systemic inflammatory response syndrome (SIRS), including Fever (temperature > 38 °C) or hypothermia (temperature < 36°C) Tachypnea (heart rate > 90 beats per minute) Respiratory rate > 20 beats per minute or Paco2 < 32 mm Hg (4.3 kPa) White blood cell count > 12,000 cells per millilitre (leukocytosis) or < 4,000 cells per milliliter (leukopenia) 3.2. Any patients are diagnosed with sepsis or have ≥ 2 points of Sequential Organ Failure Assessment (SOFA) Score or qSOFA (Quick SOFA) Score. 3.3. Any patients are diagnosed with septic shock or are received vasopressors (eg, dopamine, norepinephrine, epinephrine, vasopressin, phenylephrine), mean arterial pressure (MAP) < 65 mm Hg, and lactate > 2 mmol/L (18 mg/dL) 3.4 Any patients are received mechanical ventilation 3.5 Any patients are admitted at ICU ward. Exclusion Criteria: Patients are breast-feeding or pregnancy. Patients are insufficient or incomplete information on the medical electronic record such as patients transferred.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wichai Santimaleeworagun, PhD
Phone
663547600
Email
Swichai1234@gmail.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wichai Santimaleeworagun
Organizational Affiliation
Silpakorn University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Phramongkutklao hospital
City
Bangkok
ZIP/Postal Code
10400
Country
Thailand
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Parnrada Nulsopapon
Phone
667633120
Email
aom.olivegreen1812@gmail.com
First Name & Middle Initial & Last Name & Degree
Wichai Santimaleeworagun
First Name & Middle Initial & Last Name & Degree
Manat Pongchaidecha
First Name & Middle Initial & Last Name & Degree
Maj. Worapong Nasomsong
First Name & Middle Initial & Last Name & Degree
Parnrada Nulsopapon

12. IPD Sharing Statement

Citations:
PubMed Identifier
26903338
Citation
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
Results Reference
result
PubMed Identifier
29276050
Citation
Tillotson G. A crucial list of pathogens. Lancet Infect Dis. 2018 Mar;18(3):234-236. doi: 10.1016/S1473-3099(17)30754-5. Epub 2017 Dec 21. No abstract available.
Results Reference
result
PubMed Identifier
27080992
Citation
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016 May 15;62(10):e51-77. doi: 10.1093/cid/ciw118. Epub 2016 Apr 13.
Results Reference
result
PubMed Identifier
25737147
Citation
Asin-Prieto E, Rodriguez-Gascon A, Isla A. Applications of the pharmacokinetic/pharmacodynamic (PK/PD) analysis of antimicrobial agents. J Infect Chemother. 2015 May;21(5):319-29. doi: 10.1016/j.jiac.2015.02.001. Epub 2015 Feb 12.
Results Reference
result
PubMed Identifier
29444952
Citation
Rodriguez-Bano J, Gutierrez-Gutierrez B, Machuca I, Pascual A. Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. Clin Microbiol Rev. 2018 Feb 14;31(2):e00079-17. doi: 10.1128/CMR.00079-17. Print 2018 Apr.
Results Reference
result
PubMed Identifier
28013264
Citation
Tamma PD, Goodman KE, Harris AD, Tekle T, Roberts A, Taiwo A, Simner PJ. Comparing the Outcomes of Patients With Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia. Clin Infect Dis. 2017 Feb 1;64(3):257-264. doi: 10.1093/cid/ciw741. Epub 2016 Nov 9.
Results Reference
result
PubMed Identifier
31765385
Citation
Demidenko E, Miller TW. Statistical determination of synergy based on Bliss definition of drugs independence. PLoS One. 2019 Nov 25;14(11):e0224137. doi: 10.1371/journal.pone.0224137. eCollection 2019.
Results Reference
result
PubMed Identifier
30761114
Citation
Sheu CC, Chang YT, Lin SY, Chen YH, Hsueh PR. Infections Caused by Carbapenem-Resistant Enterobacteriaceae: An Update on Therapeutic Options. Front Microbiol. 2019 Jan 30;10:80. doi: 10.3389/fmicb.2019.00080. eCollection 2019.
Results Reference
result
PubMed Identifier
28442293
Citation
Gutierrez-Gutierrez B, Salamanca E, de Cueto M, Hsueh PR, Viale P, Pano-Pardo JR, Venditti M, Tumbarello M, Daikos G, Canton R, Doi Y, Tuon FF, Karaiskos I, Perez-Nadales E, Schwaber MJ, Azap OK, Souli M, Roilides E, Pournaras S, Akova M, Perez F, Bermejo J, Oliver A, Almela M, Lowman W, Almirante B, Bonomo RA, Carmeli Y, Paterson DL, Pascual A, Rodriguez-Bano J; REIPI/ESGBIS/INCREMENT Investigators. Effect of appropriate combination therapy on mortality of patients with bloodstream infections due to carbapenemase-producing Enterobacteriaceae (INCREMENT): a retrospective cohort study. Lancet Infect Dis. 2017 Jul;17(7):726-734. doi: 10.1016/S1473-3099(17)30228-1. Epub 2017 Apr 22.
Results Reference
result
Links:
URL
http://narst.dmsc.moph.go.th/data/AMR%202000-2019-06M.pdf
Description
Drug resistance situations from National Antimicrobial Resistance Surveillance Center Thailand (NARST) (Thai)

Learn more about this trial

Optimizing Antibiotic Dosing Regimens for the Treatment of Infection Caused by Carbapenem Resistant Enterobacteriaceae

We'll reach out to this number within 24 hrs