Combination Treatment for Enterococcus Faecalis Bacteriemia Multicenter, Observational Study"
Study Details
Study Description
Brief Summary
Prospective, multicenter, observational study on the evaluation of efficacy of appropriate monotherapy vs combination treatment for non-complicated Enterococcus faecalis bloodstream infection (EF-BSI).
The aims of our study are:
Primary:
To compare the efficacy of appropriate monotherapy vs combination treatment for EF-BSI, according to standard of care.
Secondary:
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To compare the impact on clinical outcome of the initial combination therapy in the subgroup of patients with enterococcal endocarditis. In this case we will evaluate only the antibiotic treatment administered before the diagnosis of endocarditis assuming that any case of endocarditis will be treated with a combination therapy.
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To compare the efficacy of combination treatment (vs monotherapy) in the following subgroup of patients:
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Patients with low versus high risk of endocarditis according with the "Number of positive blood cultures, Origin of the bacteremia, previous Valve disease, Auscultation of heart murmur (NOVA) score".
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Patients with metastatic septic localizations. C. Patients with catheter-related BSI.
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Patients with indwelling cardiovascular device or prosthetic valve.
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To validate the NOVA score as a predictor of enterococcal endocarditis in a large multicentre cohort of patients with EF-BSI.
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To estimate optimal duration of treatment of EF-BSI in patients without endocarditis.
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To evaluate the rate of 90-day development of Clostridium difficile infection.
The promoting center is S. Orsola-Malpighi Hospital is a 1,420-bed tertiary care University Hospital in Bologna with an average of 72,000 admissions per year. A dedicate team of Infectious Diseases (ID) specialists is active in the promoting center. Investigators of this team have already coordinated multicenter studies on infections topics. Centers from other countries will be invited to participate by email, they will be ask to fulfil an agreement form.
All consecutive, unselected patients with monomicrobial EF-BSI will be screened for study inclusion. We expect to enroll about 500 patients.
Period of data collection will be from september 2019 to 31th December 2020.
Condition or Disease | Intervention/Treatment | Phase |
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Study Design
Outcome Measures
Primary Outcome Measures
- Survival [End of Treatment, at least 2 weeks from first negative follow-up bloodculture]
Patient alive
- Body temperature (Celsius degrees) [End of Treatment, at least 2 weeks from first negative follow-up bloodculture]
Fever resolution
- Sequential Organ Failure Assessment (SOFA) Score [End of Treatment, at least 2 weeks from first negative follow-up bloodculture]
Stable or improved SOFA score. Total SOFA score ranges from 0 to 24 points. Total SOFA score consist of the sum of individual score of following items: Respiratory System (PaO2/FiO2), Cardiovascular system (Mean Arterial Pressure or administration vasopressure required), Newrvous System (Glasgow Coma Scale), Liver (bilirubin), Coagulation (platelets), Kidneys (creatinine). Each items receive a score ranging from 0 to 4 pt.
- Blood cultures [End of Treatment, at least 2 weeks from first negative follow-up bloodculture]
Follow-up Blood cultures negative for E. faecalis
- Blood cultures [90 days from End of Treatment]
No relapse of EF-BSI
- Antibiotic therapy [90 days from End of Treatment]
No need to modify initial therapy
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adult (>18 years)
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First monomicrobial EF-BSI
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Receipt of ≥ 5 days of at least one in vitro active drug (ampicillin, amoxicillin/clavulanate, ampicillin/sulbactam, piperacillin, vancomycin, teicoplanin, daptomycin and linezolid) with or without a synergistic drug (ceftriaxone, gentamycin, streptomycin), at common suggested dosages for EF-BSI in empirical or definitive therapy
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Written informed consent
Exclusion Criteria:
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Short term (within 3 days from BSI) mortality
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Other concomitant infection
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | Infectious Disease Unit - S.Orsola Malpighi Hospital | Bologna | Italy |
Sponsors and Collaborators
- University of Bologna
Investigators
- Principal Investigator: Michele Bartoletti, Dipartimento di Scienze mediche e chirurgiche, Alma Mater-University of Bologna
Study Documents (Full-Text)
None provided.More Information
Publications
- Bouza E, Kestler M, Beca T, Mariscal G, Rodríguez-Créixems M, Bermejo J, Fernández-Cruz A, Fernández-Avilés F, Muñoz P; Grupo de Apoyo al Manejo de la Endocarditis. The NOVA score: a proposal to reduce the need for transesophageal echocardiography in patients with enterococcal bacteremia. Clin Infect Dis. 2015 Feb 15;60(4):528-35. doi: 10.1093/cid/ciu872. Epub 2014 Nov 7. Erratum in: Clin Infect Dis. 2015 May 21;:.
- Cahill TJ, Prendergast BD. Infective endocarditis. Lancet. 2016 Feb 27;387(10021):882-93. doi: 10.1016/S0140-6736(15)00067-7. Epub 2015 Sep 1. Review.
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- Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med. 2002 Nov 19;137(10):791-7.
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- Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Jul 1;49(1):1-45. doi: 10.1086/599376. Erratum in: Clin Infect Dis. 2010 Apr 1;50(7):1079. Dosage error in article text. Clin Infect Dis. 2010 Feb 1;50(3):457.
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- Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
- Suppli M, Aabenhus R, Harboe ZB, Andersen LP, Tvede M, Jensen JU. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy. Clin Microbiol Infect. 2011 Jul;17(7):1078-83. doi: 10.1111/j.1469-0691.2010.03394.x. Epub 2010 Dec 3.
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- EfFAECT