Ignite Creation Date:
2024-05-05 @ 5:21 PM
Last Modification Date:
2024-10-26 @ 9:31 AM
Study NCT ID:
NCT00438269
Status:
COMPLETED
Last Update Posted:
2007-02-22
First Post:
2007-02-17
Brief Title:
Pilot Study of the Utility of Empiric Antibiotic Therapy for Suspected ICU-Acquired Infection
Sponsor:
Canadian Critical Care Trials Group
Organization:
Canadian Critical Care Trials Group
Study Overview
Official Title:
Appropriate Antimicrobial Therapy in Critical Care A Pilot Randomized Controlled Trial
Status:
COMPLETED
Status Verified Date:
2007-02
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:
Infection developing in the intensive care unit is a common complication of critical illness but notoriously difficult to diagnose A definite diagnosis based on the most reliable tests usually is not possible for at least two days It is unclear what the optimal management approach should be while awaiting the results of diagnostic tests In some circumstances broad spectrum antibiotics are started with a plan to adjust them once the results of cultures are available Observational studies show that this results in greater antibiotic use and the risk of superinfection and resistance In other circumstances antibiotics may be withheld pending the results of cultures a strategy that leads to a delay in therapy when cultures are positive and that may be associated with a worse clinical outcome
We undertook a randomized pilot study to address the question In a critically ill patient for whom clinicians are uncertain whether infection may be present and in whom potential sites of infection have been managed by removing or changing invasive devices can a policy of delaying antibiotic treatment until cultures are available reduce the risks of excessive antibiotic use without increasing the risks associated with delayed therapy
Recognizing that the question has not been formally addressed before and that approaches to clinical management are both widely divergent and passionately held our pilot study tested the feasibility and acceptability of undertaking a larger trial with sufficient power to determine equivalence
We undertook a randomized pilot study to address the question In a critically ill patient for whom clinicians are uncertain whether infection may be present and in whom potential sites of infection have been managed by removing or changing invasive devices can a policy of delaying antibiotic treatment until cultures are available reduce the risks of excessive antibiotic use without increasing the risks associated with delayed therapy
Recognizing that the question has not been formally addressed before and that approaches to clinical management are both widely divergent and passionately held our pilot study tested the feasibility and acceptability of undertaking a larger trial with sufficient power to determine equivalence
Detailed Description:
We randomized critically ill patients who had been in hospital for at least 72 hours and in the ICU for at least 24 hours and who manifested either a temperature 385 degrees or a temperature380 degrees and a white cell count 12000 and in whom clinicians entertained the possibility of infection as a diagnosis to either site-specific broad spectrum empiric antibiotics or the corresponding placebo All patients underwent a comprehensive series of investigations to identify an infectious focus and all patients had full source control including changes of central lines and urinary catheters and change of nasogastric to orogastric tubes
Patients were maintained in assigned study arm for seven days or until culture data were available at which time they were switched to culture-guided narrow spectrum therapy
Patients were maintained in assigned study arm for seven days or until culture data were available at which time they were switched to culture-guided narrow spectrum therapy
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