Usage of Procalcitonin to Reduce Antibiotics Duration in VAP in Neurosurgical ICU

Antibiotic Side Effect Clinical Trial

Official title:

Procalcitonin as a Sepsis Biomarker in Guiding Antibiotics Treatment Duration in Ventilator Associated Pneumonia in Neuro-ICU: A Randomised Controlled Trial

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06395454
• Other study ID #: USM/JEPeM/KK/24010018
• Status: Not yet recruiting
• Phase: N/A
• Start date: May 1, 2024
• Est. completion date: December 31, 2024

Study information

• Verified date: April 2024
• Source: Universiti Sains Malaysia
• Contact: Jerome Loh
• Phone: +60128589099
• Email: jeromederyang[@]hotmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Using Procalcitonin Tests to reduce antibiotics duration in Neurosurgical patients with Ventilated Associated Pneumonia

Description:

Patients who are more than 18 years old who are admitted to Neurosurgical ICU will be recruited 48hours after ventilation if matches criteria for ventilator associated pneumonia. Patients will be randomised into 2 groups. first group will be procalcitonin guided in addition to conventionally guided sepsis assessment (TWC, CRP, body temperature). second group is only conventionally guided sepsis assessment. in procalcitonin guided group, blood sample will be taken on Day 1 of recruitment and day 5. On day 5 , the procalcitonin level will be compared to recommendations in PRORATA trial. If procalcitonin level is below the level to withhold antibiotics, recommendation will be made to the primary physician to off the antibiotics. Another Procalcitonin level will be repeated on Day 7 to rule out reinfection. This study aims to compare the duration of antibiotics and length of ICU stay among the 2 groups. This study will fill up the gap among the lack of datas in neurosurgical patients.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 48
• Est. completion date: December 31, 2024
• Est. primary completion date: September 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients admitted to Neuro-ICU & Trauma ICU
• Patients aged >18 years old.
• Ventilation for >48 hours
• VAP and treated with antibiotics <24hours prior to inclusion in trial.
• Patient with arterial line or central line

Exclusion Criteria:

• Patients who are on antibiotics but not assumed or proven to have VAP
• Expected short ICU stay (<3 Days)
• Non-bacterial infections
• Long term antibiotic treatment (transplant or chemotherapy patients, endocarditis, osteomyelitis)
• Hospitalisation 48hours before enrolment
• Severe immunosuppression
• Pregnancy
• Primary team's decision to continue antibiotics for 14 days prior to trial
• DNAR or expected to die within 5 days

Related Conditions & MeSH terms

• Antibiotic Side Effect

Intervention

Diagnostic Test:
• Shorten antibiotics duration based on procalcitonin test levels
procalcitonin test will be taken on day 1 of recruitment as baseline, test done on day 5 will decide whether antibiotics will be withheld, followed by day 7 to determine rate of reinfection.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Universiti Sains Malaysia

References & Publications (17)

Annane D, Maxime V, Faller JP, Mezher C, Clec'h C, Martel P, Gonzales H, Feissel M, Cohen Y, Capellier G, Gharbi M, Nardi O. Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial. BMJ Open. 2013 Feb 14;3(2):e002186. doi: 10.1136/bmjopen-2012-002186. Print 2013. — View Citation

Bonell A, Azarrafiy R, Huong VTL, Viet TL, Phu VD, Dat VQ, Wertheim H, van Doorn HR, Lewycka S, Nadjm B. A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology. Clin Infect Dis. 2019 Jan 18;68(3):511-518. doi: 10.1093/cid/ciy543. — View Citation

Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M, Bernard M, Pasquet B, Regnier B, Brun-Buisson C, Chastre J, Wolff M; PRORATA trial group. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010 Feb 6;375(9713):463-74. doi: 10.1016/S0140-6736(09)61879-1. Epub 2010 Jan 25. — View Citation

Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med. 2000 Mar;26 Suppl 2:S148-52. doi: 10.1007/BF02900728. — View Citation

Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Muller B. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006 Jul 1;174(1):84-93. doi: 10.1164/rccm.200512-1922OC. Epub 2006 Apr 7. — View Citation

Hochreiter M, Kohler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, Schroeder S. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care. 2009;13(3):R83. doi: 10.1186/cc7903. Epub 2009 Jun 3. — View Citation

Iankova I, Thompson-Leduc P, Kirson NY, Rice B, Hey J, Krause A, Schonfeld SA, DeBrase CR, Bozzette S, Schuetz P. Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med. 2018 May;46(5):691-698. doi: 10.1097/CCM.0000000000002928. Erratum In: Crit Care Med. 2018 Sep;46(9):1560. — View Citation

Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother. 2011 Apr;66 Suppl 2:ii33-40. doi: 10.1093/jac/dkq523. — View Citation

Mazlan MZ, Ghazali AG, Omar M, Yaacob NM, Nik Mohamad NA, Hassan MH, Wan Muhd Shukeri WF. Predictors of Treatment Failure and Mortality among Patients with Septic Shock Treated with Meropenem in the Intensive Care Unit. Malays J Med Sci. 2024 Feb;31(1):76-90. doi: 10.21315/mjms2024.31.1.7. Epub 2024 Feb 28. — View Citation

Najafi A, Khodadadian A, Sanatkar M, Shariat Moharari R, Etezadi F, Ahmadi A, Imani F, Khajavi MR. The Comparison of Procalcitonin Guidance Administer Antibiotics with Empiric Antibiotic Therapy in Critically Ill Patients Admitted in Intensive Care Unit. Acta Med Iran. 2015;53(9):562-7. — View Citation

Nik Nurfazleen MZ, Mohamad Hasyizan H, Laila Ab M, Zeti Norfidiyati S, Kamaruddin I, Mahamarowi O, Mohd Zulfakar M. Clinical characteristics and factors associated with diagnoses of ventilator and non-ventilator associated pneumonia in Intensive care unit. Med J Malaysia. 2021 May;76(3):353-359. — View Citation

Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 May;46(5):888-906. doi: 10.1007/s00134-020-05980-0. Epub 2020 Mar 10. — View Citation

Rhee C. Using Procalcitonin to Guide Antibiotic Therapy. Open Forum Infect Dis. 2016 Dec 7;4(1):ofw249. doi: 10.1093/ofid/ofw249. eCollection 2017 Winter. — View Citation

Schroeder S, Hochreiter M, Koehler T, Schweiger AM, Bein B, Keck FS, von Spiegel T. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg. 2009 Mar;394(2):221-6. doi: 10.1007/s00423-008-0432-1. Epub 2008 Nov 26. — View Citation

Schuetz P, Christ-Crain M, Muller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections--hope for hype? Swiss Med Wkly. 2009 Jun 13;139(23-24):318-26. doi: 10.4414/smw.2009.12584. — View Citation

Vishalashi SG, Gupta P, Verma PK. Serum Procalcitonin as a Biomarker to Determine the Duration of Antibiotic Therapy in Adult Patients with Sepsis and Septic Shock in Intensive Care Units: A Prospective Study. Indian J Crit Care Med. 2021 May;25(5):507-511. doi: 10.5005/jp-journals-10071-23802. — View Citation

Z Mazlan M, A H Ismail M, Ali S, Salmuna ZN, Wan Muhd Shukeri WF, Omar M. Efficacy and safety of the point-of-care procalcitonin test for determining the antibiotic treatment duration in patients with ventilator-associated pneumonia in the intensive care unit: a randomised controlled trial. Anaesthesiol Intensive Ther. 2021;53(3):207-214. doi: 10.5114/ait.2021.104300. — View Citation

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	To compare the duration of antibiotics between PCT versus Standard of care guided stopping antibiotic	compare the duration of antibiotics between 2 arms	14 days
Primary	To compare the length of ICU stay in between PCT versus Standard of care guided stopping antibiotic	compare the length of ICU stay in between 2 arms	14 days
Secondary	To compare 14 days mortality rate in between 2 arms	compare 14 days mortality rate in between 2 arms	14 days
Secondary	To compare proportion of difficult to treat organisms (MRO) in between 2 arms	compare proportion of difficult to treat organisms (MRO) in between 2 arms	14 days
Secondary	To compare the proportion of reinfection within 72 hours after stopping antibiotics	compare the proportion of reinfection within 72 hours after stopping antibiotics	14 days