MEDIASTAPH: Mediastinitis and Staphylococcus Aureus

• Sponsor: Rennes University Hospital (Other)
• Overall Status: Unknown status
• CT.gov ID: NCT03262558
• Collaborator: (none)
• Enrollment: 40
• Location: 1
• Anticipated Duration (Months): 17.9
• Patients Per Site Per Month: 2.2

Study Details

Study Description

Brief Summary

Cardiac surgery with extracorporeal circulation (ECC) yields a deep immune system dysfunction that exposes patients to postoperative infectious complications. Among these, post-operative mediastinitis with Staphylococcus aureus (SA) generates significant morbidity and mortality. Two radically different approaches have been proposed in recent years to reduce the incidence of this complication. A first approach has attempted, without real success, to decrease postoperative immunosuppression. The second, more efficient, consisted of screening and preoperatively treating patients colonized with SA. However, although its incidence has decreased, postoperative mediastinitis remains a terrible nosocomial infection. The authors believe that a thorough analysis of the immunological changes induced by cardiac surgery will initiate active therapeutics to reduce the post-operative immunosuppression phase, thereby decreasing the risk of nosocomial infections. In addition, a study of the interactions between the operated (host) and staphylococcus aureus (pathogenic) immune systems will provide a better understanding of the mechanisms that expose patients to this bacterium.

Condition or Disease	Intervention/Treatment	Phase
Surgery, Cardiac; Infection	Other: No intervention

Detailed Description

In particular, changes induced by the ECC will be evaluated on:

• Indoleamine 2,3-dioxygenase activity (IDO)

• Apoptosis of lymphocytes and dendritic cells

• Polymorphonuclear neutrophils (PMNs)

• Myeloid Derived Suppressor Cells (MDSC )

After general anesthesia and arterial catheterization and prior to the start of ECC, blood samples will be taken for flow cytometry studies, for the purification of PMNs and monocytes. The purified PMNs and monocytes will then be used for the measurement of cytokine, phagocytosis and bactericidal production capacities.

The morning following surgery, blood samples will be taken and follow the same process.

Study Design

• Study Type: Observational
• Anticipated Enrollment: 40 participants
• Observational Model: Cohort
• Time Perspective: Prospective
• Official Title: Immunological and Bacteriological Approaches to the Development of Postoperative Mediastinitis With Staphylococcus Aureus
• Actual Study Start Date: Jul 4, 2016
• Anticipated Primary Completion Date: Dec 31, 2017
• Anticipated Study Completion Date: Dec 31, 2017

Arms and Interventions

Arm	Intervention/Treatment
Patients with ECC No intervention	Other: No intervention; Patients will undergo standard clinical routine practice in this indication

Outcome Measures

Primary Outcome Measures

1. Variation of plasma IDO activity [Baseline and the morning following surgery]

   IDO activity is evaluated by the Kynurenin / Tryptophan ratio before and after ECC. Enzymatic activities will be measured by high performance liquid chromatography (HPLC) on pre- and post-operative blood tests

Secondary Outcome Measures

1. Variation of phagocytosis capacity of PMNs [Baseline and the morning following surgery]

   Comparison before and after ECC

2. Variation of bactericidal capacity of PMNs [Baseline and the morning following surgery]

   Comparison before and after ECC

3. Variation of phagocytosis capacity of macrophages [Baseline and the morning following surgery]

   Comparison before and after ECC

4. Variation of bactericidal capacity of macrophages [Baseline and the morning following surgery]

   Comparison before and after ECC

5. Effect of an inhibitor of IDO on phagocytosis capacities of PMNs [The day following surgery]

6. Effect of an inhibitor of IDO on bactericidal capacities of PMNs [The day following surgery]

7. Effect of an inhibitor of IDO on phagocytosis capacities of macrophages [The day following surgery]

8. Effect of an inhibitor of IDO on bactericidal capacities of macrophages [The day following surgery]

9. Quantification of lymphocytic apoptosis before and after the ECC [Baseline and the morning following surgery]

   Quantification of apoptosis by flow cytometry

10. Quantification of lymphocytic apoptosis in the presence of an inhibitor of IDO [The day following surgery]

    Quantification of apoptosis by flow cytometry

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion criteria

• Patients over 18 years of age

• Patients who require cardiac surgery (valvular and / or coronary) with extracorporeal circulation.

Non inclusion criteria

• Chronic respiratory diseases,

• Preoperative left ventricular dysfunction (LVEF <50%),

• Immunosuppression (HIV infection, systemic corticosteroid therapy, history of cancer in the year before surgery),

• Persons subject to legal protection (safeguard of justice, curatorship, guardianship),

• Persons deprived of liberty.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Rennes Hospital University	Rennes		France	35033

Sponsors and Collaborators

• Rennes University Hospital

Investigators

• Study Director: Jean-Marc TADIE, Md, PhD, CHU Rennes

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Rennes University Hospital
• ClinicalTrials.gov Identifier: NCT03262558
• Other Study ID Numbers: 35RC16_9886
• First Posted: Aug 25, 2017
• Last Update Posted: Aug 25, 2017
• Last Verified: Aug 1, 2017

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Rennes University Hospital: staphylococcus aureus; nosocomial infection
• Additional relevant MeSH terms: Mediastinitis

Study Results

No Results Posted as of Aug 25, 2017