Ignite Creation Date:
2024-05-05 @ 4:45 PM
Last Modification Date:
2024-10-26 @ 9:24 AM
Study NCT ID:
NCT00309114
Status:
COMPLETED
Last Update Posted:
2017-02-23
First Post:
2006-03-30
Brief Title:
Prevention of Urinary Tract Infection UTI in Persons With Spinal Cord Injury SCI
Sponsor:
Baylor College of Medicine
Organization:
Baylor College of Medicine
Study Overview
Official Title:
Prevention of UTI in Persons With Spinal Cord Injury
Status:
COMPLETED
Status Verified Date:
2017-02
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Urinary tract infection UTI is the most common infection in patients with spinal cord injury SCI and is linked to major undesired results or complications including death The bladder of SCI patients especially those with indwelling catheters is usually colonized by bacteria some of which do and others which do not cause symptoms of UTI Bacteria that do not cause symptoms are often called benign colonizers and are often left untreated because they may provide some protection against infection with more harmful bacteria This idea of using benign bacteria to prevent infections with symptoms is called bacterial interference A prototype strain Escherichia coli 83972 was shown to begin and continue for extended periods of time non symptom causing colonization of the human bladder and to hold back symptom causing infections of the neurogenic bladder Data from pilot studies at two medical centers indicated that bacterial interference might be a useful therapy for reducing the rate or frequency of UTI in SCI patients Because almost all SCI patients have a UTI at some time and also the large costs of treating this infection studying the impact of bladder colonization with E coli 83972 on the rate of symptom causing UTI has an amazing potential for improving the quality of life of SCI patients and decreasing the cost of health care Like with other preventive plans such as vaccination for instance it is important to explore the effectiveness of this new preventive approach The project is a prospective randomized double blind multi-center study that deals with specific pieces of bacterial interference in SCI patients
HYPOTHESES Placing non symptom causing bacteria E coli 83972 into SCI patients bladders reduces the rate of symptom causing UTI
A SPECIFIC AIM Determine how bladder colonization with E coli 83972 or similar bacteria affects the rate of symptom causing urinary tract infections in a large group of SCI and Spina Bifida patients by conducting a prospective randomized placebo-controlled multi-center clinical trial
HYPOTHESES Placing non symptom causing bacteria E coli 83972 into SCI patients bladders reduces the rate of symptom causing UTI
A SPECIFIC AIM Determine how bladder colonization with E coli 83972 or similar bacteria affects the rate of symptom causing urinary tract infections in a large group of SCI and Spina Bifida patients by conducting a prospective randomized placebo-controlled multi-center clinical trial
Detailed Description:
This clinical trial will be take place in a total of 7 medical centers that care for Spinal cord injury SCI and Spina Bifida patients A total of 160 patients will be allowed to take part in the study
The study coordinator will interview patients by telephone and in person who express an interest in taking part in the study After an informed consent and HIPAA documents are reviewed and all of the patients questions are answered then they will be asked to sign these two forms Then a code number will be assigned to each patient and used along with their initials to identify them for the remainder of the study All study participants will have a complete history and physical examination including ASIA classification serum creatinine and a urine culture immediately upon entry into the study One of the following 3 diagnostic tests must be completed within the 3 months before the study KUB IVP or non-contrast abdominal CT scan A voiding cystourethrogram with fluoroscopy VCUG alone or as part of a video urodynamics evaluation must be completed within 1 year before the study
Randomization and sample size Enrolled subjects will be randomized in a 31 ratio to receive bladder inoculation either with E coli 83972 experimental group or with placebo control group This randomization ratio was selected because around 13 of colonized subjects are expected to remain colonized for 12 months
Bladder inoculation At study entry a urine culture and sensitivity test will be completed using a fresh mid stream after the urine is flowing urine sample removed via a catheter into the bladder Subjects will stop all actions to prevent or slow urinary tract infection UTI for at least two weeks upon entry into the study Each subject will be treated with correct antibiotics for 7 - 10 days and any existing urinary catheter changed three days after starting antibiotic treatment Forty-eight to 72 hours or 80 to 90 hours for fluoroquinolone antibiotics after completion of antibiotics the urine will be re-cultured and the lower urinary tract inoculated with E coli 83972 or placebo
Most subjects even those with external condom catheters have worn a Foley catheter at some time and would be expected to know the catheter size that best fits them Subjects will be inoculated on three consecutive days Inoculation will consist of putting into the bladder via a sterile catheter 10 ml of normal saline alone or containing E coli 83972 Subjects who are incontinent at low bladder volumes will be monitored with a Foley catheter balloon blocking the bladder neck or diversion stoma for 30 minutes after inoculation After 30 min the clamp will be released and the bladder allowed to drain for an additional 30 min The bladder inoculation will be repeated a second time unless an unexpected adverse event complication is encountered After the catheter is un-clamped for the second time the subject will be observed for 30 min before discharge
If the 48-hour culture from the sample taken just prior to inoculation is positive for bacteria and E coli 83972 colonization was not present in the sample another antibiotic treatmentinoculation cycle will be attempted The timing of the second attempt will be decided by the CORE director and the local principal investigator At the correct time another 7-10 day course of antibiotic therapy will be repeated Three days after starting antibiotics any existing urinary catheter will be changed Forty-eight to 72 hours or 80 to 90 hours for fluoroquinolone antibiotics after completion of this course of antibiotics the urine will be re-cultured and then the bladder re-inoculated If the 48 hour culture taken just prior to this inoculation is again positive for any bacteria other than E coli 83972 and E coli 83972 colonization is not present as a result of the second inoculation cycle a third cycle of antibiotic treatmentinoculation will be attempted The timing of the 3rd attempt will be decided by the CORE director and the local principal investigator No further colonization attempts will be made in study participants who are not colonized after three sets of attempts We will continue to monitor subjects in this group for the remaining months of the study but for analysis purposes they will be treated as never colonized
All inoculated subjects who remain without symptoms will return to their study center to have a urine sample collected and a brief medical interview one week after inoculation and monthly for the remaining 12 months The CORE director can allow a subject who lives far from any center to mail their monthly urine samples directly to the CORE All needed supplies such as urine specimen containers proper shipping containers labels pre-paid postage etc will be provided at no cost to the subject The subjects study site will contact them to conduct the brief medical interview
At the end of 12 months subjects will receive an antibiotic to clear E coli 83972 from their bladder and the study will be finished If a subject experienced an adverse event something unexpected during the study they will be followed by the research staff until the event has gone back to normal or resolved
Growth of E coli 83972 in the urine will indicate bladder colonization Subjects will be considered colonized as long as E coli 83972 is present and even if there are other bacteria in the urine Subjects who develop symptoms of a UTI will be treated with proper antibiotics guided by susceptibility patterns for the bacterias grown from urine cultures Urine cultures collected prior to starting treatment will be tested for E coli 83972 It is important to note that although the method of bladder inoculation carries some risk of causing symptoms of a UTI that risk is rather small and will be shared by all subjects
There exists a risk that clamping of the bladder for 30 minutes may result in autonomic dysreflexia in some patients especially those who dump urine All subjects will be asked about a history of autonomic dysreflexia or any unexpected response to bladder filling prior to inoculation Before beginning inoculation urodynamics data will be reviewed All subjects with a lesion level above T7 will have their blood pressure BP monitored every 3 - 5 minutes while the catheter is clamped If the subject reports any symptoms associated with autonomic dysreflexia eg headache sweating flushing and so forth or if the BP monitor records a systolic or diastolic BP 20 mm Hg above baseline or in any case if the systolic BP exceeds 150 or the diastolic BP exceeds 100 mm Hg the catheter will be un-clamped Monitoring will continue until the subject is without symptoms with their baseline BPs Interventions including elevating the head of the bed lowering the legs as well as pharmacologic measures nitropaste nifedipine etc will be used if needed The use of pharmacologic measures and any other measures will follow the Clinical Procedures Guidelines for acute management of autonomic dysreflexia published by the Paralyzed Veterans of America
The study coordinator will interview patients by telephone and in person who express an interest in taking part in the study After an informed consent and HIPAA documents are reviewed and all of the patients questions are answered then they will be asked to sign these two forms Then a code number will be assigned to each patient and used along with their initials to identify them for the remainder of the study All study participants will have a complete history and physical examination including ASIA classification serum creatinine and a urine culture immediately upon entry into the study One of the following 3 diagnostic tests must be completed within the 3 months before the study KUB IVP or non-contrast abdominal CT scan A voiding cystourethrogram with fluoroscopy VCUG alone or as part of a video urodynamics evaluation must be completed within 1 year before the study
Randomization and sample size Enrolled subjects will be randomized in a 31 ratio to receive bladder inoculation either with E coli 83972 experimental group or with placebo control group This randomization ratio was selected because around 13 of colonized subjects are expected to remain colonized for 12 months
Bladder inoculation At study entry a urine culture and sensitivity test will be completed using a fresh mid stream after the urine is flowing urine sample removed via a catheter into the bladder Subjects will stop all actions to prevent or slow urinary tract infection UTI for at least two weeks upon entry into the study Each subject will be treated with correct antibiotics for 7 - 10 days and any existing urinary catheter changed three days after starting antibiotic treatment Forty-eight to 72 hours or 80 to 90 hours for fluoroquinolone antibiotics after completion of antibiotics the urine will be re-cultured and the lower urinary tract inoculated with E coli 83972 or placebo
Most subjects even those with external condom catheters have worn a Foley catheter at some time and would be expected to know the catheter size that best fits them Subjects will be inoculated on three consecutive days Inoculation will consist of putting into the bladder via a sterile catheter 10 ml of normal saline alone or containing E coli 83972 Subjects who are incontinent at low bladder volumes will be monitored with a Foley catheter balloon blocking the bladder neck or diversion stoma for 30 minutes after inoculation After 30 min the clamp will be released and the bladder allowed to drain for an additional 30 min The bladder inoculation will be repeated a second time unless an unexpected adverse event complication is encountered After the catheter is un-clamped for the second time the subject will be observed for 30 min before discharge
If the 48-hour culture from the sample taken just prior to inoculation is positive for bacteria and E coli 83972 colonization was not present in the sample another antibiotic treatmentinoculation cycle will be attempted The timing of the second attempt will be decided by the CORE director and the local principal investigator At the correct time another 7-10 day course of antibiotic therapy will be repeated Three days after starting antibiotics any existing urinary catheter will be changed Forty-eight to 72 hours or 80 to 90 hours for fluoroquinolone antibiotics after completion of this course of antibiotics the urine will be re-cultured and then the bladder re-inoculated If the 48 hour culture taken just prior to this inoculation is again positive for any bacteria other than E coli 83972 and E coli 83972 colonization is not present as a result of the second inoculation cycle a third cycle of antibiotic treatmentinoculation will be attempted The timing of the 3rd attempt will be decided by the CORE director and the local principal investigator No further colonization attempts will be made in study participants who are not colonized after three sets of attempts We will continue to monitor subjects in this group for the remaining months of the study but for analysis purposes they will be treated as never colonized
All inoculated subjects who remain without symptoms will return to their study center to have a urine sample collected and a brief medical interview one week after inoculation and monthly for the remaining 12 months The CORE director can allow a subject who lives far from any center to mail their monthly urine samples directly to the CORE All needed supplies such as urine specimen containers proper shipping containers labels pre-paid postage etc will be provided at no cost to the subject The subjects study site will contact them to conduct the brief medical interview
At the end of 12 months subjects will receive an antibiotic to clear E coli 83972 from their bladder and the study will be finished If a subject experienced an adverse event something unexpected during the study they will be followed by the research staff until the event has gone back to normal or resolved
Growth of E coli 83972 in the urine will indicate bladder colonization Subjects will be considered colonized as long as E coli 83972 is present and even if there are other bacteria in the urine Subjects who develop symptoms of a UTI will be treated with proper antibiotics guided by susceptibility patterns for the bacterias grown from urine cultures Urine cultures collected prior to starting treatment will be tested for E coli 83972 It is important to note that although the method of bladder inoculation carries some risk of causing symptoms of a UTI that risk is rather small and will be shared by all subjects
There exists a risk that clamping of the bladder for 30 minutes may result in autonomic dysreflexia in some patients especially those who dump urine All subjects will be asked about a history of autonomic dysreflexia or any unexpected response to bladder filling prior to inoculation Before beginning inoculation urodynamics data will be reviewed All subjects with a lesion level above T7 will have their blood pressure BP monitored every 3 - 5 minutes while the catheter is clamped If the subject reports any symptoms associated with autonomic dysreflexia eg headache sweating flushing and so forth or if the BP monitor records a systolic or diastolic BP 20 mm Hg above baseline or in any case if the systolic BP exceeds 150 or the diastolic BP exceeds 100 mm Hg the catheter will be un-clamped Monitoring will continue until the subject is without symptoms with their baseline BPs Interventions including elevating the head of the bed lowering the legs as well as pharmacologic measures nitropaste nifedipine etc will be used if needed The use of pharmacologic measures and any other measures will follow the Clinical Procedures Guidelines for acute management of autonomic dysreflexia published by the Paralyzed Veterans of America
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| H-8393 | OTHER | Baylor College of Medicine | None |