The Amputation Surgical Site Infection Trial (ASSIT)

NCT ID: NCT02018094

Last Updated: 2019-07-15

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

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

160 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-10-08

Study Completion Date

2017-01-02

Brief Summary

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* Lower limb amputations are performed usually as a last resort in patients with acute and chronic limb ischaemia (CLI) caused by vascular disease, poorly controlled diabetes or, infection.
* In the period 2003-2008 there were approximately 5,000 amputations per year in the UK.
* The Centre for Disease Control defines a Surgical Site Infection (SSI) as an infection within 30 days of an operation or up to one year if an implant is left in place and the infection is related to an operative procedure.
* Figures from the Surgical Site Infection Surveillance reported that the highest rate of surgical site infection was reported in association with lower limb amputation at 13.1%.
* There is a clear under-representation and the infection rate within our institution is approximately 25% which reflects the infection rate reported in a recent trial by Sadat et al (22.5%)
* Prevention of surgical site infections is of paramount importance to patients, healthcare providers and policy-makers, as they impact on morbidity and mortality and have significant time and cost implications.
* Currently there is NO CONSENSUS as to what the best practice is towards antibiotic administration in such patients. From a questionnaire-based audit we performed including vascular departments across the entire country, practice varies in both course duration (single dose → 5 days antibiotic course) as well as choice of antibiotics.
* The guideline at our institution suggests the 5-day course of antibiotic prophylaxis. The course duration varies depending on the clinical picture as well as microbiology results and recommendations.
* There are no randomised control trials that have investigated this aspect of patient care. We have set up one such trial and through it, we are looking to establish a standard practice which will hopefully be as beneficial as possible to the patient but also cost-effective for NHS.

Detailed Description

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As above

Conditions

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Wound Infection Amputation Wound

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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24 hour antibiotic course

24 hours of the stated antibiotics administered intravenously (Augmentin and metronidazole. Teicoplanin and or gentamicin will be used if penicillin allergic and state of renal function)

Group Type ACTIVE_COMPARATOR

Co-amoxiclav

Intervention Type DRUG

Augmentin 1.2g IV three times daily for 24 hours. If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.

Iodine

Intervention Type DRUG

Intra-operative skin preparation prior to incision to skin.

Metronidazole

Intervention Type DRUG

500mg IV three times daily for 24 hours. If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course

Chlorhexidine

Intervention Type DRUG

Alcoholic Chlorhexidine skin pre-op preparation

Teicoplanin

Intervention Type DRUG

Teicoplanin 400mg on induction. If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days

5 day antibiotic Course

24 hours of IV antibiotics followed by 4 days of oral antibiotics (Augmentin and metronidazole. Teicoplanin and or gentamicin will be used if penicillin allergic and state of renal function. Clindamycin will be used as a an oral replacement for penicillin allergic patients)

Group Type ACTIVE_COMPARATOR

Co-amoxiclav

Intervention Type DRUG

Augmentin 1.2g IV three times daily for 24 hours. If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.

Iodine

Intervention Type DRUG

Intra-operative skin preparation prior to incision to skin.

Metronidazole

Intervention Type DRUG

500mg IV three times daily for 24 hours. If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course

Chlorhexidine

Intervention Type DRUG

Alcoholic Chlorhexidine skin pre-op preparation

Teicoplanin

Intervention Type DRUG

Teicoplanin 400mg on induction. If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days

Clindamycin

Intervention Type DRUG

Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy

Iodine

Skin Preparation used pre-operatively: Alcoholic Povidone

Group Type ACTIVE_COMPARATOR

Co-amoxiclav

Intervention Type DRUG

Augmentin 1.2g IV three times daily for 24 hours. If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.

Iodine

Intervention Type DRUG

Intra-operative skin preparation prior to incision to skin.

Metronidazole

Intervention Type DRUG

500mg IV three times daily for 24 hours. If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course

Teicoplanin

Intervention Type DRUG

Teicoplanin 400mg on induction. If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days

Clindamycin

Intervention Type DRUG

Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy

Chlorhexidine

Skin preparation to be used preoperatively: Alcoholic chlorhexidine

Group Type ACTIVE_COMPARATOR

Co-amoxiclav

Intervention Type DRUG

Augmentin 1.2g IV three times daily for 24 hours. If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.

Metronidazole

Intervention Type DRUG

500mg IV three times daily for 24 hours. If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course

Chlorhexidine

Intervention Type DRUG

Alcoholic Chlorhexidine skin pre-op preparation

Teicoplanin

Intervention Type DRUG

Teicoplanin 400mg on induction. If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days

Clindamycin

Intervention Type DRUG

Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy

Interventions

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Co-amoxiclav

Augmentin 1.2g IV three times daily for 24 hours. If the patient is randomised to the 5-day duration antibiotic arm then Augmentin 625mg oral tablets three times daily are added to the 24 hour course for a further 4 days.

Intervention Type DRUG

Iodine

Intra-operative skin preparation prior to incision to skin.

Intervention Type DRUG

Metronidazole

500mg IV three times daily for 24 hours. If the patient is randomised to 5-day duration arm, then another 4 days of oral metronidazole at 400mg three times daily is added to the course

Intervention Type DRUG

Chlorhexidine

Alcoholic Chlorhexidine skin pre-op preparation

Intervention Type DRUG

Teicoplanin

Teicoplanin 400mg on induction. If penicillin allergic and on 5-day antibiotic arm then add clindamycin 300mg 4 times daily for further 4 days

Intervention Type DRUG

Clindamycin

Clindamycin 300mg 4 times daily orally to be used in case of penicillin allergy

Intervention Type DRUG

Other Intervention Names

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Augmentin Povidone iodine (alcoholic solution) Flagyl Hydrex

Eligibility Criteria

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Inclusion Criteria

1. Adults ≥18 yrs undergoing lower limb amputations who are able to consent to the trial.
2. Able to understand the Patient Information Sheet and capable and willing to give informed consent and follow the protocol requirements (including attending all follow-up visits)

Exclusion Criteria

1. Allergies to chlorhexidine/ alcohol/ iodophors
2. Inability to give informed consent
3. Patients who are admitted to hospital with severe sepsis secondary to gas gangrene requiring multiple operations and admission to Intensive Care Unit.
4. Aged under 18 years at the time of recruitment
5. Use of investigational drug/device therapy within preceding 4 weeks that may interfere with this study.
6. Toe amputations
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Hull

OTHER

Sponsor Role collaborator

Hull University Teaching Hospitals NHS Trust

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hull Royal Infirmary

Hull, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Souroullas P, Barnes R, Carradice D, Smith G, Huang C, Chetter I. Extended-course antibiotic prophylaxis in lower limb amputation: randomized clinical trial. Br J Surg. 2022 Apr 19;109(5):426-432. doi: 10.1093/bjs/znac053.

Reference Type DERIVED
PMID: 35325055 (View on PubMed)

Other Identifiers

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ASSIT Trial

Identifier Type: -

Identifier Source: org_study_id

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