Shorter Versus Extended Course of Antibiotic Therapy for Necrotizing Soft Tissue Infections
- Conditions
- Necrotizing Soft Tissue Infection
- Interventions
- Other: Antibiotic duration
- Registration Number
- NCT06002607
- Lead Sponsor
- University of California, Irvine
- Brief Summary
Necrotizing soft tissue infection (NSTI) is a devastating disease that results in a high rate of in-hospital complications and despite advances in critical care, wound care, and early intervention, NSTI continues to be associated with a mortality rate of nearly 30%. The antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. Although one of the tenets of management for NSTI is early broad-spectrum intravenous antibiotics (listed above), the duration of antibiotics needed is not well defined. Currently, there exists wide variation in the duration of antibiotics for NSTI ranging between 2-16 days. The objective of this study is to evaluate the safety of a shorter course of antibiotics hypothesizing that a short duration of antibiotics for 48-hours after source-control is achieved will have similar risk of morbidity and mortality compared to a 7-day course of antibiotics post source control. A second aim of this study will be to identify if serum procalcitonin levels/ratio correspond to resolution of systemic infection in patients with NSTI.
- Detailed Description
The objective of this study is to evaluate the safety of a shorter course of antibiotics hypothesizing that a short duration of antibiotics for 48-hours after source-control is achieved will have similar risk of morbidity and mortality compared to a 7-day course of antibiotics post source control. The proposed shortened duration is considered within standard of care as the IDSA suggests 48-72 hours of antibiotics after source control, however this was due mostly to expert opinion until a recent single-center study using historical controls demonstrated a 48-hour duration of antibiotics to be safe. A second aim of this study will be to identify if serum procalcitonin levels/ratio correspond to resolution of systemic infection in patients with NSTI. This pilot study may help limit use of antibiotics which are associated with both cost and significant adverse events including antimicrobial resistance and clostridium difficile infections. In addition, the data would support grant submission of a larger, multi-center study with sufficient power to demonstrate the safety profile and potential benefits of a shorter duration of antibiotics, which has been shown to be beneficial in previous large surgical infection studies.
Specific Aims:
Aim#1: Establish the safety of an abbreviated course (48 hours after source control) compared to a prolonged (7 days after source control) course of antibiotics in terms of in-hospital mortality.
Aim#2: Compare the incidence of hospital length of stay and in-hospital complications including unplanned return to the operating room, ventilator days, and antibiotic associated complications (e.g., clostridium difficile infection) in the two comparison groups: abbreviated (48-hours) and prolonged antibiotics (7-days) after source control.
Aim#3: Identify a critical threshold of biochemical procalcitonin or a % decrease in procalcitonin from the initial procalcitonin obtained upon admission that suggests resolution of systemic infection in patients with NSTI. This will be done by obtaining a serum procalcitonin upon admission and daily for up to 7 days from admission or once source control has been achieved.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 50
- Adult patients 18 years of age or older with all following criteria:
- Presenting to the Emergency Department with history, exam and/or imaging concerning NSTI, AND
- Patients who undergo consultation by the Emergency General Surgery service, AND
- Patients included must have skin or soft tissue findings consistent with NSTI (erythema, crepitus, or pain out of proportion to exam), AND
- Systemic signs of infection including fever (temperature >38.0°C) or leukocytosis (≥11,000 peripheral white cells per cubic millimeter), AND
- Patients who undergo excisional debridement and/or amputation to achieve source control.
- Pregnant patients
- Prisoners
- Patients with bacteremia upon admission
- Patients unable to provide consent (including no legally authorized representative)
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Short course of antibiotics Antibiotic duration Patients assigned to a 48-hour course of antibiotics. As the current standard of care, the antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin-Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. The specific choice of antibiotic therapy will not be dictated by the study protocol but by the attending surgeon taking care of the patient Long course of antibiotics Antibiotic duration Patients assigned to a 7 day course of antibiotics. As the current standard of care, the antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin-Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. The specific choice of antibiotic therapy will not be dictated by the study protocol but by the attending surgeon taking care of the patient
- Primary Outcome Measures
Name Time Method Safety of the antibiotic course duration Through study completion, an average of 1 year In-hospital complications
Mortality rate Through study completion, an average of 1 year In-hospital mortality
- Secondary Outcome Measures
Name Time Method Serum concentration of C-reactive protein Through study completion, an average of 1 year C-reactive protein milligrams/liter
Serum concentration of glucose Through study completion, an average of 1 year Glucose milligrams/deciliter
Total ventilator days Through study completion, an average of 1 year Total days of ventilation support for the patient
Total hospital length of stay Through study completion, an average of 1 year Total days of hospital stay
BMI (body mass index) Baseline, pre-intervention/procedure/surgery Body mass index (weight and height will be combined to report BMI in kg/m\^2)
Blood Pressure Baseline, pre-intervention/procedure/surgery Blood Pressure (mmHg)
Heart Rate Baseline, pre-intervention/procedure/surgery Heart rate (beats/minute)
NSTI location Baseline, pre-intervention/procedure/surgery Anatomical location of soft tissue infection
Serum concentration of procalcitonin Upon admission and daily blood sample for 7 days Procalcitonin ng/mL
Serum concentration of white blood cell Through study completion, an average of 1 year White blood cell count cells per microliter (cells/μL)
Serum concentration of hemoglobin Through study completion, an average of 1 year Hemoglobin grams/deciliter
Serum concentration of creatinine Through study completion, an average of 1 year Creatinine milligram/deciliter
Age Baseline, pre-intervention/procedure/surgery Age in years
Respiratory rate Baseline, pre-intervention/procedure/surgery Respiratory rate (breaths/minute)
Operations Through study completion, an average of 1 year Number of surgical procedures
Sex Baseline, pre-intervention/procedure/surgery Sex (male/female)
Temperature Baseline, pre-intervention/procedure/surgery Temperature (Fahrenheit)
Comorbidities Baseline, pre-intervention/procedure/surgery Comorbidities (e.g., diabetes, hypertension, cirrhosis, chronic kidney disease, etc.)
Transfusion requirements Baseline, pre-intervention/procedure/surgery Number of Packed Red Blood Cells transfused measured in milliliters
Serum concentration of sodium Through study completion, an average of 1 year Sodium millimoles per liter (mmol/L)
Total intensive care unit (ICU) Through study completion, an average of 1 year Total days of ICU stay
Trial Locations
- Locations (1)
University of California Irvine Medical Center
🇺🇸Orange, California, United States