Infection Clinical Trial
— DIANAOfficial title:
DetermInants of Antimicrobial Use aNd De-escalAtion in Critical Care (DIANA Study)
NCT number | NCT02920463 |
Other study ID # | EC/2016/0938 |
Secondary ID | |
Status | Completed |
Phase | |
First received | |
Last updated | |
Start date | October 1, 2016 |
Est. completion date | June 30, 2018 |
Verified date | September 2019 |
Source | University Hospital, Ghent |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
DetermInants of Antimicrobial use aNd de-escalAtion in critical care (DIANA study), is a multicenter, international, prospective, observational cohort study, aiming to describe the rate of de-escalation as well as the associated outcome and the empirical antibiotic therapy for infections at the intensive care unit.
Status | Completed |
Enrollment | 1495 |
Est. completion date | June 30, 2018 |
Est. primary completion date | June 30, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Age 18 years or older. - Patient is admitted to an ICU and has an anticipated need of ICU support of at least 48 hours. - Patient has a suspected or confirmed bacterial infection (community-, healthcare-, hospital- or ICU-acquired). - Empirical antibiotic therapy is started for this infection at any time in the ICU or no more than 24 hours prior to ICU admission. If the initial antibiotic therapy is considered inadequate and another empirical scheme is chosen at ICU admission, this will be the empirical antibiotic of the study. - Causative pathogen and susceptibility are unidentified at time of initiation of the antibiotic therapy (Gram staining results may be known). - Signed informed consent (if required by local ethics committee). Exclusion Criteria: - Previous inclusion in this study for another infection - each patient can only be included once. |
Country | Name | City | State |
---|---|---|---|
Belgium | Ghent University Hospital | Ghent |
Lead Sponsor | Collaborator |
---|---|
University Hospital, Ghent |
Belgium,
Leone M, Bechis C, Baumstarck K, Lefrant JY, Albanèse J, Jaber S, Lepape A, Constantin JM, Papazian L, Bruder N, Allaouchiche B, Bézulier K, Antonini F, Textoris J, Martin C; AZUREA Network Investigators. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial. Intensive Care Med. 2014 Oct;40(10):1399-408. doi: 10.1007/s00134-014-3411-8. Epub 2014 Aug 5. Erratum in: Intensive Care Med. 2014 Nov;40(11):1794. — View Citation
Tabah A, Cotta MO, Garnacho-Montero J, Schouten J, Roberts JA, Lipman J, Tacey M, Timsit JF, Leone M, Zahar JR, De Waele JJ. A Systematic Review of the Definitions, Determinants, and Clinical Outcomes of Antimicrobial De-escalation in the Intensive Care Unit. Clin Infect Dis. 2016 Apr 15;62(8):1009-1017. doi: 10.1093/cid/civ1199. Epub 2015 Dec 23. Review. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of patients in which the empirical antibiotic therapy is de-escalated | Included patients will be monitored for 28 days. This is the number of patients in which the empirical antibiotic therapy is de-escalated during the time of observation. | 28 days | |
Primary | Proportion of patients with clinical cure at day 7 in de-escalated patients versus non-deescalated patients | This is the proportion of patients in which the infection under study is clinically cured, which is defined as: 'disappearance of all signs and symptoms related to the infection under study' in de-escalated versus non-deescalated patients. | 7 days | |
Secondary | Antibiotics used in empirical antimicrobial therapy in critically ill patients | Which antibiotic categories are chosen empirically to treat the infection under study in all critically ill patients included during the study period. | 28 days | |
Secondary | Proportion of appropriate empirical antibiotic therapy in critically ill patients | This is the proportion of all empirical antibiotic prescriptions that has in-vitro activity against all causative pathogens. | 28 days | |
Secondary | Antibiotics used in definitive antimicrobial therapy in critically ill patients | Which antibiotic categories are chosen as definitive antimicrobial therapy to treat the infection under study in all critically ill patients included during the study period. | 28 days | |
Secondary | Duration of antimicrobial treatment for the infection under study in de-escalated patients versus non-deescalated patients | 28 days | ||
Secondary | Duration of hospitalization on the intensive care unit in de-escalated patients versus non-deescalated patients | 28 days | ||
Secondary | Number of antibiotic free days in de-escalated patients versus non-deescalated patients | 28 days | ||
Secondary | Proportion of patients who died at day 28 in de-escalated patients versus non-deescalated patients | 28 days | ||
Secondary | Proportion of patients in whom drug-resistant pathogens emerge in de-escalated patients versus non-deescalated patients | Included patients will be monitored for 28 days. This is the proportion of multidrug resistant, extensively drug-resistant, pandrug- resistant pathogens and pathogens resistant to the administered empirical antibiotic therapy that emerge in de-escalated patients versus non-deescalated patients | 28 days | |
Secondary | Proportion of patients with infection relapse, superinfections and subsequent infections in de-escalated patients versus non-deescalated patients | Infection relapse being defined as an infection occurring after stopping all antimicrobial agents for the primary infection under study with the same causative microorganism (a different susceptibility pattern may be present). Subsequent infection being defined as an infection occurring after stopping all antimicrobial agents for the primary infection under study, with a different causative microorganism. Superinfection being defined as an infection superimposed on the primary infection under study with a different causative microorganism. |
28 days | |
Secondary | Proportion of antimicrobial prescriptions in which a loading dose is used | 28 days | ||
Secondary | Proportion of antimicrobial prescriptions which are administered in a continuous or extended infusion | 28 days |
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