Medical Education for Sepsis Source Control and Antibiotics

NCT ID: NCT01187134

Last Updated: 2017-08-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

4138 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-07-31

Study Completion Date

2013-07-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Patients with severe sepsis or septic shock suffer from life-threatening infections. Fast and adequate therapy with antibiotics is crucial for survival. Current guidelines recommend the application of broad-spectrum antibiotics within 1 hour after diagnosis. However, recent studies showed that such treatment is delayed for several hours.

In this study, medical staff of participating hospitals is trained to achieve a duration until antimicrobial therapy of less than 1 hour. Tools of change management are used. The data are compared to a control group (hospitals without intervention).

It is hypothesized that a multifaceted educational program decreases duration until antimicrobial therapy and improves survival.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

This study is a cluster randomized trial (CRT) where the hospitals are the clusters. 44 hospitals in Germany have confirmed their participation. Hospitals are randomized into two groups: a control and an interventional group. The control group receives conventional CMEs. The interventional group receives tools for increasing awareness such as posters and brochures. Quality measure such as benchmarking and feedback of quality indicators are used. Depending on the improvement process tools such as SWOT analyses and resistance radar will be implemented.

The CRT was preceded by a 5 months observational study (Dec. 2010 - April 2011). In about 1000 patients, participating hospitals documented their patients with severe sepsis or septic shock into a register. These data are used for final sample size calculation of the CRT and for stratification of the randomization.

The groups switch after completion of the CRT and observation continues. Thus, centers of the control group now receive the change management while the former intervention group is now without external support and is assessed for sustainability of the intervention. This study phase is planned for Nov. 2013 until March 2015. Sample size will be calculated when the CRT has been finished.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Sepsis Shock, Septic

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Intervention group

Group Type ACTIVE_COMPARATOR

Change Management

Intervention Type BEHAVIORAL

Hospitals have to create local change teams which are supported and trained by the study center. Local awareness of the staff is increased by PowerPoint presentations, posters, and brochures. The change teams receive monthly information about their quality indicator (duration until antimicrobial therapy). Anonymous comparison to other hospitals is possible (Benchmarking). Hospitals are visited three times a year to discuss progress of quality. In case of failure to improve, the change team is supported with specific tools for change management such as SWOT-analysis or resistance radar.

Conventional CME

Hospitals receive conventional continuing medical education in lecture style twice a year. They receive current publications and recommendations for national and international meetings regarding diagnosis and therapy of sepsis.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Change Management

Hospitals have to create local change teams which are supported and trained by the study center. Local awareness of the staff is increased by PowerPoint presentations, posters, and brochures. The change teams receive monthly information about their quality indicator (duration until antimicrobial therapy). Anonymous comparison to other hospitals is possible (Benchmarking). Hospitals are visited three times a year to discuss progress of quality. In case of failure to improve, the change team is supported with specific tools for change management such as SWOT-analysis or resistance radar.

Intervention Type BEHAVIORAL

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

1. For the hospitals (cluster):

* Involved in the primary care of patients with severe sepsis/septic shock
* Willing to participate in a guideline implementation process
2. For the patients:

* New onset of suspicion of severe sepsis or septic shock in the following settings:

1. Prehospital
2. Emergency department
3. Operating theatre
4. Regular ward
5. Intensive care unit (ICU)/Intermediate Care Unit (IMC)

Exclusion Criteria

1. For the hospitals (cluster):

* No intensive care unit available
* no acute care for patients with severe sepsis and septic shock
2. For the patients:

* Start of sepsis therapy in a non-study site
* Patients not admitted to the ICU/IMC
* No commitment to full medical support (i.e. DNR)
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Center for Sepsis Control and Care, Germany

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Frank Bloos

Lead investigator of the MEDUSA study group

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Reinhart Konrad, MD

Role: PRINCIPAL_INVESTIGATOR

Jena University Hospital, Germany

Frank Bloos, MD, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Jena University Hospital

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Universitätklinikum Aachen

Aachen, , Germany

Site Status

Ilm-Kreis-Kliniken Arnstadt-Ilmenau GmbH

Arnstadt, , Germany

Site Status

HELIOS Klinikum Aue

Aue, , Germany

Site Status

Zentralklinik Bad Berka GmbH

Bad Berka, , Germany

Site Status

Hufelandkrankenhaus GmbH

Bad Langensalza, , Germany

Site Status

Bundeswehrkrankenhaus Berlin

Berlin, , Germany

Site Status

Charité Berlin

Berlin, , Germany

Site Status

HELIOS Kliniken Berlin-Buch

Berlin, , Germany

Site Status

HELIOS Klinikum Emil von Behring

Berlin, , Germany

Site Status

Vivantes Klinikum Neukölln

Berlin, , Germany

Site Status

Ev. Krankenhaus Bielefeld

Bielefeld, , Germany

Site Status

HELIOS St. Josefs-Hospital Bochum-Linden

Bochum, , Germany

Site Status

Universitätsklinikum Carl Gustav Carus

Dresden, , Germany

Site Status

St. Georg Klinikum Eisenach gGmbH

Eisenach, , Germany

Site Status

Waldkrankenhaus Rudolf Elle GmbH

Eisenberg, , Germany

Site Status

Helios Klinikum Erfurt

Erfurt, , Germany

Site Status

Katholisches Krankenhaus St. Johann Nepomuk

Erfurt, , Germany

Site Status

Bürgerhospital Friedberg

Friedberg, , Germany

Site Status

SRH Waldklinikum Gera

Gera, , Germany

Site Status

Klinik am Eichert

Göppingen, , Germany

Site Status

Ernst-Moritz-Arndt-Universität Greifswald

Greifswald, , Germany

Site Status

Ilm-Kreis-Kliniken Arnstadt-Ilmenau GmbH

Ilmenau, , Germany

Site Status

Universitätsklinikum Jena

Jena, , Germany

Site Status

Universitätsklinikum Kiel

Kiel, , Germany

Site Status

HELIOS-Klinikum Krefeld GmbH

Krefeld, , Germany

Site Status

Krankenhaus Landshut-Achdorf

Landshut, , Germany

Site Status

Universitätsklinikum Leipzig

Leipzig, , Germany

Site Status

Klinikum Meiningen GmbH

Meiningen, , Germany

Site Status

Saale-Unstrut-Klinikum Naumburg

Naumburg, , Germany

Site Status

Südharz-Krankenhaus Nordhausen gGmbH

Nordhausen, , Germany

Site Status

Klinikum Oldenburg

Oldenburg, , Germany

Site Status

Thüringen-Klinik Pößneck gGmbH

Pößneck, , Germany

Site Status

ASKLEPIOS-ASB Krankenhaus Radeberg GmbH

Radeberg, , Germany

Site Status

Thüringen-Kliniken "Georgius Agricola" GmbH

Saalfeld, , Germany

Site Status

Klinikum Saarbrücken gGmbH

Saarbrücken, , Germany

Site Status

Diakonie-Klinikum Schwäbisch-Hall gGmbH

Schwäbisch Hall, , Germany

Site Status

Ev. Jung-Stilling-Krankenhaus

Siegen, , Germany

Site Status

SRH Zentralklinikum Suhl GmbH

Suhl, , Germany

Site Status

Universitätsklinikum Tübingen

Tübingen, , Germany

Site Status

Universitätsklinikum Ulm

Ulm, , Germany

Site Status

Sophien- und Hufeland-Klinikum gGmbH

Weimar, , Germany

Site Status

HELIOS Klinikum Wuppertal

Wuppertal, , Germany

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Germany

References

Explore related publications, articles, or registry entries linked to this study.

Bloos F, Thomas-Ruddel D, Ruddel H, Engel C, Schwarzkopf D, Marshall JC, Harbarth S, Simon P, Riessen R, Keh D, Dey K, Weiss M, Toussaint S, Schadler D, Weyland A, Ragaller M, Schwarzkopf K, Eiche J, Kuhnle G, Hoyer H, Hartog C, Kaisers U, Reinhart K; MEDUSA Study Group. Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study. Crit Care. 2014 Mar 3;18(2):R42. doi: 10.1186/cc13755.

Reference Type RESULT
PMID: 24589043 (View on PubMed)

Matthaeus-Kraemer CT, Thomas-Rueddel DO, Schwarzkopf D, Rueddel H, Poidinger B, Reinhart K, Bloos F. Crossing the handover chasm: Clinicians' perceptions of barriers to the early detection and timely management of severe sepsis and septic shock. J Crit Care. 2016 Dec;36:85-91. doi: 10.1016/j.jcrc.2016.06.034. Epub 2016 Jul 9.

Reference Type RESULT
PMID: 27546753 (View on PubMed)

Schwarzkopf D, Ruddel H, Thomas-Ruddel DO, Felfe J, Poidinger B, Matthaus-Kramer CT, Hartog CS, Bloos F. Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians. Crit Care Med. 2017 Mar;45(3):e265-e273. doi: 10.1097/CCM.0000000000002081.

Reference Type RESULT
PMID: 27776092 (View on PubMed)

Matthaeus-Kraemer CT, Thomas-Rueddel DO, Schwarzkopf D, Rueddel H, Poidinger B, Reinhart K, Bloos F. Barriers and supportive conditions to improve quality of care for critically ill patients: A team approach to quality improvement. J Crit Care. 2015 Aug;30(4):685-91. doi: 10.1016/j.jcrc.2015.03.022. Epub 2015 Apr 1.

Reference Type RESULT
PMID: 25891644 (View on PubMed)

Thomas-Rueddel DO, Poidinger B, Weiss M, Bach F, Dey K, Haberle H, Kaisers U, Ruddel H, Schadler D, Scheer C, Schreiber T, Schurholz T, Simon P, Sommerer A, Schwarzkopf D, Weyland A, Wobker G, Reinhart K, Bloos F; Medical Education for Sepsis Source Control and Antibiotics Study Group. Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock. J Crit Care. 2015 Apr;30(2):439.e1-6. doi: 10.1016/j.jcrc.2014.10.027. Epub 2014 Oct 30.

Reference Type RESULT
PMID: 25466313 (View on PubMed)

Bloos F, Ruddel H, Thomas-Ruddel D, Schwarzkopf D, Pausch C, Harbarth S, Schreiber T, Grundling M, Marshall J, Simon P, Levy MM, Weiss M, Weyland A, Gerlach H, Schurholz T, Engel C, Matthaus-Kramer C, Scheer C, Bach F, Riessen R, Poidinger B, Dey K, Weiler N, Meier-Hellmann A, Haberle HH, Wobker G, Kaisers UX, Reinhart K; MEDUSA study group. Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial. Intensive Care Med. 2017 Nov;43(11):1602-1612. doi: 10.1007/s00134-017-4782-4. Epub 2017 May 2.

Reference Type RESULT
PMID: 28466151 (View on PubMed)

Schwarzkopf D, Matthaeus-Kraemer CT, Thomas-Ruddel DO, Ruddel H, Poidinger B, Bach F, Gerlach H, Grundling M, Lindner M, Scheer C, Simon P, Weiss M, Reinhart K, Bloos F; MEDUSA study group. A multifaceted educational intervention improved anti-infectious measures but had no effect on mortality in patients with severe sepsis. Sci Rep. 2022 Mar 10;12(1):3925. doi: 10.1038/s41598-022-07915-9.

Reference Type DERIVED
PMID: 35273276 (View on PubMed)

Ruddel H, Thomas-Ruddel DO, Reinhart K, Bach F, Gerlach H, Lindner M, Marshall JC, Simon P, Weiss M, Bloos F, Schwarzkopf D; MEDUSA study group. Adverse effects of delayed antimicrobial treatment and surgical source control in adults with sepsis: results of a planned secondary analysis of a cluster-randomized controlled trial. Crit Care. 2022 Feb 28;26(1):51. doi: 10.1186/s13054-022-03901-9.

Reference Type DERIVED
PMID: 35227308 (View on PubMed)

Thomas-Ruddel DO, Hoffmann P, Schwarzkopf D, Scheer C, Bach F, Komann M, Gerlach H, Weiss M, Lindner M, Ruddel H, Simon P, Kuhn SO, Wetzker R, Bauer M, Reinhart K, Bloos F; MEDUSA study group. Fever and hypothermia represent two populations of sepsis patients and are associated with outside temperature. Crit Care. 2021 Oct 21;25(1):368. doi: 10.1186/s13054-021-03776-2.

Reference Type DERIVED
PMID: 34674733 (View on PubMed)

Thomas-Ruddel DO, Poidinger B, Kott M, Weiss M, Reinhart K, Bloos F; MEDUSA study group. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care. 2018 May 13;22(1):128. doi: 10.1186/s13054-018-2050-9.

Reference Type DERIVED
PMID: 29753321 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

01EO1002

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

U1111-1118-2850

Identifier Type: OTHER

Identifier Source: secondary_id

C1.1

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.