Bacterial Infection Clinical Trial
Official title:
Randomized, Multi-Center, Comparative Trial of Short-Course Empiric Antibiotic Therapy Versus Standard Antibiotic Therapy for Subjects With Pulmonary Infiltrates in the Intensive Care Unit (ICU): Impact on Antimicrobial Resistance, Superinfections, Length of ICU Stay and Hospitalization, and Mortality
This study will enroll 460 subjects who have new pulmonary infiltrates during their ICU stay and who are at low risk of having pneumonia, as determined using the Clinical Pulmonary Infection Score (CPIS). The study is designed to determine whether 3 days of antibiotic treatment with meropenem (with or without coverage for MRSA) for ICU subjects diagnosed with new pulmonary infiltrates can reduce the emergence of anti-microbial-resistant organisms and the isolation of a potential pathogen compared to a standard course of antibiotic therapy (minimum of 8 days of therapy with antibiotics of the primary care team's choosing). Subjects will be randomly placed in either the meropenem group or standard antibiotic therapy group. The study will also examine whether short-course therapy reduces hospital length of stay and hospital cost, without having a negative effect on subject morbidity and mortality.
Status | Terminated |
Enrollment | 460 |
Est. completion date | February 2007 |
Est. primary completion date | February 2007 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: 1. Subject, or legal representative, has given written informed consent. 2. Subject has developed a new pulmonary infiltrate after ICU admission (confirmed by radiology). 3. Subject has been hospitalized at least three days. 4. CPIS </= 6. 5. 18 years of age or older. Exclusion Criteria: 1. Burn patients. 2. Cystic fibrosis patients. 3. Bone marrow or solid organ transplant patients. 4. Neutropenia from any cause (absolute neutophil count (ANC) </= 500) or likely to become neutropenic within 7 days, 5. Known or suspected Human Immunodeficiency Virus (HIV) infection (HIV test is not required). 6. Suspected or proven extrapulmonary infection site requiring antibiotic therapy. 7. History of anaphylaxis to penicillin or cephalosporins. 8. History of anaphylaxis to meropenem (any component of the formulation) or other carbapenem (e.g., imipenem). 9. On systemic antibiotics for more than 7 consecutive days during the previous 30 days. 10. Received more than 2 doses of systemic antibiotics within the past 24 hours (other than those used for surgical prophylaxis), 9. Pregnant or lactating (Women of childbearing potential must have a negative serum or urine pregnancy test within the 7 days prior to the first dose of antibiotics). 10. Unlikely to survive past Day 7 of the study (as determined by the primary care team). 11. Previous enrollment in this study. |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
United States | Akron General Medical Center- Medicine | Akron | Ohio |
United States | University of Maryland Medical Center | Baltimore | Maryland |
United States | University of Alabama at Birmingham | Birmingham | Alabama |
United States | Roswell Park Cancer Institute - Infectious Diseases | Buffalo | New York |
United States | University of Miami | Miami | Florida |
United States | Saint Patricks Hospital and Health Sciences Center | Missoula | Montana |
United States | Christiana Care Health Services | Newark | Delaware |
United States | University of Oklahoma | Oklahoma City | Oklahoma |
United States | South Texas Veterans Health Care System | San Antonio | Texas |
United States | Washington University in St. Louis | St. Louis | Missouri |
Lead Sponsor | Collaborator |
---|---|
National Institute of Allergy and Infectious Diseases (NIAID) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Combined measure of either emergence of antimicrobial resistance or isolation of a potential pathogen detected in any positive clinical cultures that are deemed a clinically significant infection | Day 0 to day 28 (or hospital discharge, if earlier) | Yes | |
Secondary | ICU and Hospital length of stay (LOS) | Through Day 28 (or hospital discharge, if greater) | No | |
Secondary | Health Economics: The costs will be based on ICU LOS, hospital LOS, antibiotic treatment, and standardized costs related to the treatment of infection-related adverse experiences. | Through Day 28 (or hospital dischange, if greater) | No | |
Secondary | Any clinically significant infection, as determined by the subject's primary care team. | Through Day 28 (or hospital dischange, if greater) | Yes | |
Secondary | Mortality rates at Days 14 and 28. | Days 14 and 28. | Yes |
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