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Oxygen-ozone Therapy Plus Antibiotic Therapy in the Treatment of Infections Secondary to Implant of Orthopaedic Devices

Primary Purpose

Infection

Status
Unknown status
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Oxygen-ozone therapy
Sponsored by
Società Scientifica Internazionale di Ossigeno Ozono Terapia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Infection focused on measuring Infection, Orthopaedic device

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed written informed consent;
  2. Male or female aged ≥ 18 years;
  3. Patient having undergone surgery for implant of an orthopaedic device in the previous 8 weeks;
  4. Presence of at least one (but no more than 3) post-operative wounds in the site of surgery (ulcers, eschars, sores);
  5. Presence of at least one symptom (pain, burning, redness and malodour) and at least one sign (erythema, local warmth, swelling, purulent secretion) of infection of at least moderate intensity (score ≥ 2) in the target lesion at the screening visit (Visit 1), to be confirmed again at the baseline visit (Visit 2);
  6. Wound area of the target lesion ≤ 100 cm2;
  7. Patient with presence at least one pathogen identified in the swab collection in the target lesion, which is amenable to be eradicated with oral antibiotic therapy;
  8. In case of multiple wounds (however not more than three), non-target lesions must not overlap with the target one (i.e. the largest one);
  9. Patient able to perform the wound self-care at home or care by his/her primary caregiver;
  10. Willing to refrain from all non-permitted concomitant medication from the screening visit through to the entire study duration.
  11. Female subjects of childbearing potential must have a negative urinary pregnancy test at Screening and must practice a reliable method of contraception throughout the study;
  12. Patient able to read and understand the study procedures, the requirements for follow-up visits, willing to provide information at the scheduled evaluations and willing, able and ensuring to comply with the study requirements for the whole study period.

Exclusion Criteria:

  1. Wounds without signs of localized infection;
  2. Presence of more than four wounds;
  3. Presence of one or more wounds with area > 100 cm2;
  4. Presence of undermining wounds;
  5. Patients with favism, i.e. deficiency of the glucose-6-phosphate dehydrogenase (G6PD) enzyme;
  6. Patients with uncontrolled hyperthyroidism;
  7. Patients with history of connective tissue disease, e.g., mixed connective tissue disease;
  8. Patients with active malignant disease;
  9. Patients with other clinically significant diseases, or other major diseases deemed clinically significant by the Investigator or which in the opinion of the Investigator would interfere with the study procedures or study outcome;
  10. Patients candidate to any surgery during the overall study duration;
  11. Treatment with topical corticosteroids in the previous 4 weeks and/or with systemic corticosteroids in the previous 7 days;
  12. Treatment with any hydrating and/or moisturizing cream in the previous 24 hours.
  13. Patients on treatment with chemotherapeutic agents, radiation therapy or immunosuppressive therapies;
  14. Patients with contraindications to antibiotic therapy;
  15. Pregnant, breastfeeding women and female child-bearing potential who are not using a highly effective method of birth control and not willing to use it during the participation to the study;
  16. Participation in any clinical research study evaluating another investigational drug or device within 30 days prior to consenting to study entry;
  17. Patient unable to understand informed consent or having a high probability of non-compliance with the study procedures and or non-completion of the study according to investigator's judgement.

Sites / Locations

  • Pineta Grande Hospital
  • Ospedale di Fidenza
  • ASST Fatebenefratelli Sacco
  • AORN Cardarelli
  • Istituto Clinico Beato Matteo
  • ASUR AV5

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Arm A

Arm B

Arm Description

Oxygen-ozone therapy plus antibiotic therapy

Antibiotic therapy

Outcomes

Primary Outcome Measures

Clinical success at Day 14
Resolution/improvement of signs and symptoms of infection of the wound in the target lesion (i.e. a score ≤ 1 for a maximum of two signs/symptoms) from baseline to Day 14. The following symptoms will be evaluated by patients on a 0-4 point Likert scale (0 = no symptom; 1 = mild symptom; 2 = moderate symptom; 3 = severe symptom; 4 = very severe symptom): pain, burning, redness and malodour. The following signs will be evaluated by investigators on a 0-4 point Likert scale (0 = no sign; 1 = mild sign; 2 = moderate sign; 3 = severe sign; 4 = very severe sign): erythema, local warmth, swelling, purulent secretion.

Secondary Outcome Measures

Proportion of patients with clinical success at Day 7, Day 28, and Day 42
Clinical success is defined as resolution/improvement of signs and symptoms of infection of the wound in the target lesion
Time to resolution of all signs and symptoms of infection
It is defined as the disappearance (score = 0) of all signs and symptoms of infection of the wound in the target lesion;
Eradication of the pathogen isolated at the screening visit
Bacteriological success of the wound in the target lesion at Day 14 (V4) and Day 42 (V6).A bacteriological success is defined as eradication of the pathogen isolated at the screening visit, without superinfection or reinfection with the same pathogen;
Changes from baseline to any post-baseline time-point of the size of the target lesion
Global assessment of the target lesion at Day 14 and Day 42
Investigators will be requested to score the outcome of the target lesion on a five-grade scale: 1= worsening, 2 = no change, 3 = minimal improvement, 4 = moderate improvement and 5 = good improvement/resolution;
Changes from baseline to any post-baseline time-point in body temperature
Changes in WBCs count
Changes from baseline to Day 14 (V4) and Day 42 (V6) of white blood cells count (a laboratory parameters that is indicative of infection)
Changes in Erythrocyte sedimentation rate
Changes from baseline to Day 14 (V4) and Day 42 (V6) of ESR values (a laboratory parameters that is indicative of infection)
Changes in High-sensitivity C-reactive protein
Changes from baseline to Day 14 (V4) and Day 42 (V6) of hs-CRP values (a laboratory parameters that is indicative of infection)

Full Information

First Posted
February 18, 2021
Last Updated
March 5, 2021
Sponsor
Società Scientifica Internazionale di Ossigeno Ozono Terapia
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1. Study Identification

Unique Protocol Identification Number
NCT04787575
Brief Title
Oxygen-ozone Therapy Plus Antibiotic Therapy in the Treatment of Infections Secondary to Implant of Orthopaedic Devices
Official Title
Open-label, Multicentre, Randomized, Parallel Group Study to Assess the Efficacy and Safety of Oxygen-ozone Therapy Plus Oral Antibiotic Therapy in the Treatment of Infections Secondary to Implant of Orthopaedic Devices
Study Type
Interventional

2. Study Status

Record Verification Date
March 2021
Overall Recruitment Status
Unknown status
Study Start Date
June 1, 2021 (Anticipated)
Primary Completion Date
June 1, 2022 (Anticipated)
Study Completion Date
September 1, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Società Scientifica Internazionale di Ossigeno Ozono Terapia

4. Oversight

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

5. Study Description

Brief Summary
This is an open-label, multicentre, randomized, parallel group study to evaluate the efficacy of treatment with oxygen-ozone therapy plus oral antibiotic therapy, in comparison with oral antibiotic therapy alone, in the proportion of patients with resolution/improvement of signs and symptoms of infection of the wound (e.g. ulcer, eschar, sore) in the target lesion after 14 days of treatment, in patients with infections secondary to implant of orthopaedic devices.
Detailed Description
This will be an open-label, multicentre, randomized, parallel group study. The study plan will include a screening visit (Visit 1, Day -7/-3) in which patients will be screened on the basis of inclusion/exclusion criteria and clinically evaluated. At the end of the 3-7 days of run-in (Visit 2, Baseline visit, Day 0), patient still eligible will be randomised to one of the two following treatment groups: Oxygen-ozone therapy SIOOT plus antibiotic therapy Antibiotic therapy Patients in both groups will receive oral antibiotic therapy, which will be prescribed at discretion of the Investigator, based on the results of the colture of the swab collected in the target lesion at the screening visit (and later, if needed) and the associated antibiogram. Follow-up visits will be performed after 7 days (Visit 3, Day 7), 14 days (Visit 4, Day 14), 28 days (Visit 5, Day 28) and 42 days (Visit 6, End of study, Day 42) from the start of treatment. A visit window of ± 2 days for the date of Visits 3-5 and of ± 3 days for the date of Visits 6 will be allowed. Patients prematurely discontinued from the study will perform an 'Early termination visit', in which procedures schedule for Visit 6 (End of study, Day 42) will be performed. In case of premature study discontinuation, the Investigator will duly record the reason for premature withdrawal in the appropriate section of the case report form (eCRF). Visit 6, or the 'Early termination Visit' will represent the conclusion of patient's participation in the investigation.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Infection
Keywords
Infection, Orthopaedic device

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Open-label, multicentre, randomized, parallel group study
Masking
None (Open Label)
Allocation
Randomized
Enrollment
186 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm A
Arm Type
Experimental
Arm Description
Oxygen-ozone therapy plus antibiotic therapy
Arm Title
Arm B
Arm Type
Other
Arm Description
Antibiotic therapy
Intervention Type
Procedure
Intervention Name(s)
Oxygen-ozone therapy
Intervention Description
Oxygen-ozone therapy (group a) will be performed by: i) Self-haemoinfusion of 200 cc. with concentrations of 40-50 μg/ml, to be performed two/three times a week, for a time of 6 weeks (for a maximum of 15 sessions); ii) Subcutaneous injections in the perilesional site at the dose of 5 cc. with concentrations of 4 μg,/ml, Cleanse wounds with 100 cc of 5-10 ug ozone gas
Primary Outcome Measure Information:
Title
Clinical success at Day 14
Description
Resolution/improvement of signs and symptoms of infection of the wound in the target lesion (i.e. a score ≤ 1 for a maximum of two signs/symptoms) from baseline to Day 14. The following symptoms will be evaluated by patients on a 0-4 point Likert scale (0 = no symptom; 1 = mild symptom; 2 = moderate symptom; 3 = severe symptom; 4 = very severe symptom): pain, burning, redness and malodour. The following signs will be evaluated by investigators on a 0-4 point Likert scale (0 = no sign; 1 = mild sign; 2 = moderate sign; 3 = severe sign; 4 = very severe sign): erythema, local warmth, swelling, purulent secretion.
Time Frame
2 week
Secondary Outcome Measure Information:
Title
Proportion of patients with clinical success at Day 7, Day 28, and Day 42
Description
Clinical success is defined as resolution/improvement of signs and symptoms of infection of the wound in the target lesion
Time Frame
Day 7, Day 28, and Day 42
Title
Time to resolution of all signs and symptoms of infection
Description
It is defined as the disappearance (score = 0) of all signs and symptoms of infection of the wound in the target lesion;
Time Frame
7 weeks
Title
Eradication of the pathogen isolated at the screening visit
Description
Bacteriological success of the wound in the target lesion at Day 14 (V4) and Day 42 (V6).A bacteriological success is defined as eradication of the pathogen isolated at the screening visit, without superinfection or reinfection with the same pathogen;
Time Frame
7 weeks
Title
Changes from baseline to any post-baseline time-point of the size of the target lesion
Time Frame
7 weeks
Title
Global assessment of the target lesion at Day 14 and Day 42
Description
Investigators will be requested to score the outcome of the target lesion on a five-grade scale: 1= worsening, 2 = no change, 3 = minimal improvement, 4 = moderate improvement and 5 = good improvement/resolution;
Time Frame
7 weeks
Title
Changes from baseline to any post-baseline time-point in body temperature
Time Frame
7 weeks
Title
Changes in WBCs count
Description
Changes from baseline to Day 14 (V4) and Day 42 (V6) of white blood cells count (a laboratory parameters that is indicative of infection)
Time Frame
7 weeks
Title
Changes in Erythrocyte sedimentation rate
Description
Changes from baseline to Day 14 (V4) and Day 42 (V6) of ESR values (a laboratory parameters that is indicative of infection)
Time Frame
7 weeks
Title
Changes in High-sensitivity C-reactive protein
Description
Changes from baseline to Day 14 (V4) and Day 42 (V6) of hs-CRP values (a laboratory parameters that is indicative of infection)
Time Frame
7 weeks
Other Pre-specified Outcome Measures:
Title
Number of subjects experiencing treatment-emergent adverse events and serious TEAEs
Time Frame
7 weeks
Title
Number of subjects experiencing local TEAEs in the site of application of the IP
Time Frame
7 weeks
Title
Changes from baseline to any post-baseline time point in blood pressure
Description
Systolic and diastolic blood pressure will be measured at each study visit in sitting position after at least 10 minutes rest
Time Frame
7 weeks
Title
Changes from baseline to any post-baseline time point in heart rate
Description
Heart rate will be recorded at each study visit; it will be measured for one minute just prior to the sitting blood pressure measurement.
Time Frame
7 weeks
Title
Changes in haemoglobin values
Description
Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in haematocrit values
Description
Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in red blood cell (RBC) count
Description
Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in platelet count
Description
Haematology will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in creatinine values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in blood urea nitrogen (BUN) values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in glucose values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in aspartate aminotransferase (AST) values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in alanine aminotransferase (ALT) values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in gamma-glutamyl transpeptidase (gamma-GT) values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in alkaline phosphatase values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in total bilirubin values
Description
Blood chemistry will be evaluated in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in sodium values
Description
Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in potassium values
Description
Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in magnesium values
Description
Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in chloride values
Description
Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks
Title
Changes in calcium values
Description
Electrolytes will be evaluated in blood in the reference local laboratory of each investigational study site at the screening visit (Visit 1, Day -7/-3) and at Visit 4 (Day 14) and Visit 6 (Day 42).
Time Frame
7 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed written informed consent; Male or female aged ≥ 18 years; Patient having undergone surgery for implant of an orthopaedic device in the previous 8 weeks; Presence of at least one (but no more than 3) post-operative wounds in the site of surgery (ulcers, eschars, sores); Presence of at least one symptom (pain, burning, redness and malodour) and at least one sign (erythema, local warmth, swelling, purulent secretion) of infection of at least moderate intensity (score ≥ 2) in the target lesion at the screening visit (Visit 1), to be confirmed again at the baseline visit (Visit 2); Wound area of the target lesion ≤ 100 cm2; Patient with presence at least one pathogen identified in the swab collection in the target lesion, which is amenable to be eradicated with oral antibiotic therapy; In case of multiple wounds (however not more than three), non-target lesions must not overlap with the target one (i.e. the largest one); Patient able to perform the wound self-care at home or care by his/her primary caregiver; Willing to refrain from all non-permitted concomitant medication from the screening visit through to the entire study duration. Female subjects of childbearing potential must have a negative urinary pregnancy test at Screening and must practice a reliable method of contraception throughout the study; Patient able to read and understand the study procedures, the requirements for follow-up visits, willing to provide information at the scheduled evaluations and willing, able and ensuring to comply with the study requirements for the whole study period. Exclusion Criteria: Wounds without signs of localized infection; Presence of more than four wounds; Presence of one or more wounds with area > 100 cm2; Presence of undermining wounds; Patients with favism, i.e. deficiency of the glucose-6-phosphate dehydrogenase (G6PD) enzyme; Patients with uncontrolled hyperthyroidism; Patients with history of connective tissue disease, e.g., mixed connective tissue disease; Patients with active malignant disease; Patients with other clinically significant diseases, or other major diseases deemed clinically significant by the Investigator or which in the opinion of the Investigator would interfere with the study procedures or study outcome; Patients candidate to any surgery during the overall study duration; Treatment with topical corticosteroids in the previous 4 weeks and/or with systemic corticosteroids in the previous 7 days; Treatment with any hydrating and/or moisturizing cream in the previous 24 hours. Patients on treatment with chemotherapeutic agents, radiation therapy or immunosuppressive therapies; Patients with contraindications to antibiotic therapy; Pregnant, breastfeeding women and female child-bearing potential who are not using a highly effective method of birth control and not willing to use it during the participation to the study; Participation in any clinical research study evaluating another investigational drug or device within 30 days prior to consenting to study entry; Patient unable to understand informed consent or having a high probability of non-compliance with the study procedures and or non-completion of the study according to investigator's judgement.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Marianno Franzini
Phone
035 19910105
Email
info@ossigenoozono.it
Facility Information:
Facility Name
Pineta Grande Hospital
City
Castel Volturno
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Antonio Guastafierro
Email
drantonio.guastafierro@gmail.com
Facility Name
Ospedale di Fidenza
City
Fidenza
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Luca Marziani
Email
l.marziani@asul.pr.it
Facility Name
ASST Fatebenefratelli Sacco
City
Milano
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alfonso Manzotti
Email
alfonso.manzotti@asst-fbf-sacco.it
Facility Name
AORN Cardarelli
City
Napoli
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Fabio Di Santo
Email
Fabio.disanto@aocardarelli.it
Facility Name
Istituto Clinico Beato Matteo
City
Pavia
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pietro Gallotti
Email
gallotti.pietro@gmail.com
Facility Name
ASUR AV5
City
San Benedetto Del Tronto
Country
Italy
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tiziana Principi
Email
tiziana.principi@sanita.marche.it

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Oxygen-ozone Therapy Plus Antibiotic Therapy in the Treatment of Infections Secondary to Implant of Orthopaedic Devices

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