Study to Assess Management and Outcomes of Hospitalised Patients With Complicated UTI (RESCUING)

NCT ID: NCT02641015

Last Updated: 2017-01-18

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

Total Enrollment

1028 participants

Study Classification

OBSERVATIONAL

Study Start Date

2015-12-31

Study Completion Date

2016-08-31

Brief Summary

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A retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant gram-negative bacteria (COMBACTE-MAGNET,WP5)

Detailed Description

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Bacterial resistance to antimicrobial drugs is a major public health problem. Of greatest concern is the rapid emergence and dissemination of resistance to third generation cephalosporins in Enterobacteriaceae, especially Escherichia coli and Klebsiella pneumoniae. This is frequently seen in association with resistance to other classes of antibiotics leading to a multidrug resistance (MDR) profile. These MDR isolates are often involved in complicated urinary tract infection (cUTI), and are associated with poor clinical outcomes. In addition, in the last decade there has been an emergence of carbapenemase-producing Enterobacteriaceae, which are also resistant to other antibiotics than carbapenems, leaving few therapeutic options.

The overall aim of this study is to provide information about the epidemiology, clinical management and outcome of patients hospitalised with cUTI, including pyelonephritis. To achieve this aim, the investigators will perform a multicentre retrospective observational study in patients with hospitalised cUTI. The study will be conducted in several European countries plus Israel, which have a high prevalence of MDR Gram-negative bacteria (GNB), including Pseudomonas aeruginosa. The study will seek to identify possible modifiable risk factors for treatment failure, especially those related to antibiotic therapy.

On completion of this study, the investigators will develop a better understanding of the clinical management of hospitalised patients with cUTI due to MDR GNB in European countries. The investigators will identify the modifiable risk factors for treatment failure. This information will be used to inform better clinical and antibiotic management of cUTI to improve patient outcomes. The study will also be used in the development of hypothesis for future randomised controlled trials in cUTI with new antibiotics. Dissemination of results will take place through peer-reviewed publications and conference presentations.

Conditions

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Urinary Tract Infections Bacterial Resistance

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

Patients with UTI and at least one of the following underlying conditions:

* Indwelling urinary catheter
* Urinary retention (at least 100ml of residual urine after voiding)
* Neurogenic bladder
* Obstructive uropathy (e.g. nephrolithiasis, fibrosis)
* Renal impairment caused by intrinsic renal disease: Estimated glomerular filtration rate (eGFR) \<60 mL/min
* Renal transplantation
* Urinary tract modifications, such as an ileal loop or pouch
* Pyelonephritis and normal urinary tract anatomy

and at least one of the following signs or symptoms:

* Chills or rigors associated with fever or hypothermia (temperature greater than 38ºC or below 36ºC)
* Flank pain (pyelonephritis) or pelvic pain (cUTI)
* Dysuria, urinary frequency, or urinary urgency
* Costo-vertebral angle tenderness on physical examination
* UTI-related altered mental state

and at least one of the following microbiological results:

* Urine culture with at least 105 CFU/mL or greater of a uropathogen (no more than 2 species)
* At least one blood culture growing possible uropathogens (no more than 2 species) with no other evident site of infection

Exclusion Criteria

* Patients less than 18 years of age
* Prostatitis
* Polymicrobial infections that include Candida spp.
* Polymicrobial infections that include more than 2 bacterial species
* cUTI with Candida spp. as sole uropathogen
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Tel Aviv University

OTHER

Sponsor Role collaborator

AiCuris Anti-infective Cures AG

INDUSTRY

Sponsor Role collaborator

University of Bristol

OTHER

Sponsor Role collaborator

UMC Utrecht

OTHER

Sponsor Role collaborator

Institut d'Investigació Biomèdica de Bellvitge

OTHER

Sponsor Role lead

Responsible Party

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Miquel Pujol

PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Dora Tancheva, Mrs

Role: PRINCIPAL_INVESTIGATOR

Emergency Hospital Pirogov, Sofia, Bulgaria

Rossitza Vatcheva-Dobrevska, Prof

Role: PRINCIPAL_INVESTIGATOR

University Hospital Queen Joanna, Sofia, Bulgaria

Sotirios Tsiodras, Prof

Role: PRINCIPAL_INVESTIGATOR

Attikon University Hospital, Athens, Greece

Emmanuel Roilides, Prof

Role: PRINCIPAL_INVESTIGATOR

Hippokration Hospital, Thessaloniki, Greece

Istvan Vakonyi, MD

Role: PRINCIPAL_INVESTIGATOR

Kenezy University Hospital,Debrecen, Hungary

Aniko Farkas, MD

Role: PRINCIPAL_INVESTIGATOR

Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház (SZSZBMK). Nyíregyháza, Hungary

Leonard Leibovici, Prof

Role: PRINCIPAL_INVESTIGATOR

Beilinson Hospital, Rabin Medical Center. Petah-TiqvaI, Israel

Mical Paul, Prof

Role: PRINCIPAL_INVESTIGATOR

Rambam Health Care Campus. Haifa, Israel

Yehuda Carmeli, Prof

Role: PRINCIPAL_INVESTIGATOR

Tel Aviv Medical Center, Tel Aviv. Israel

Emanuele Durante Mangoni, Prof

Role: PRINCIPAL_INVESTIGATOR

AORN dei Colli Monaldi. Napoli, Italy

Erica Franceschini, MD

Role: PRINCIPAL_INVESTIGATOR

Azienda ospedaliero-universitaria policlinico di modena, Modena, Italy

Nicola Petrosillo, MD

Role: PRINCIPAL_INVESTIGATOR

National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy

Andrei Ursache, MD

Role: PRINCIPAL_INVESTIGATOR

"Spitalul Clinic de Urgenta Bucuresti. Popular unoficial name ""Floreasca "" Hospital", Bucharest, Romania

Judit Bodnár, MD

Role: PRINCIPAL_INVESTIGATOR

Soproni Erzsébet Oktató Kórház és Rehabilitációs Intézet, Sopron, Hungary

Yehuda Carmeli, Prof

Role: PRINCIPAL_INVESTIGATOR

Tel Aviv Medical Center, Tel Aviv, Israel

Andrei Vata, MD

Role: PRINCIPAL_INVESTIGATOR

Infectious Diseases Hospital Sfanta Parascheva Iasi, Iasi, Romania

Adriana Hristea, MD

Role: PRINCIPAL_INVESTIGATOR

National Institute for Infectious Diseases Prof Dr Matei Bals, Bucharest, Romania

Jesus Rodriguez-Bano, Prof

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Virgen Macarena, Seville, Spain

Julia Origüen, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario 12 de Octubre, Madrid, Spain

Arzu Yetkin, MD

Role: PRINCIPAL_INVESTIGATOR

Ankara Numune Egitim ve ArastÄrma Hastanesi, Ankara, Turkey

Nese Saltoglu, Prof

Role: PRINCIPAL_INVESTIGATOR

Istanbul University Cerrahpasa Medical School, Istambul, Turkey

Miquel Pujol, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari de Bellvitge, Barcelona, Spain

Locations

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Emergency Hospital Pirogov

Sofia, , Bulgaria

Site Status

University Hospital Queen Joanna

Sofia, , Bulgaria

Site Status

Attikon University Hospital

Athens, , Greece

Site Status

Hippokration Hospital

Thessaloniki, , Greece

Site Status

Kenezy University Hospital

Debrecen, , Hungary

Site Status

Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház (SZSZBMK)

Nyíregyháza, , Hungary

Site Status

Soproni Erzsébet Oktató Kórház és Rehabilitációs Intézet

Sopron, , Hungary

Site Status

Rambam Health Care Campus

Haifa, , Israel

Site Status

Beilinson Hospital, Rabin Medical Center

Petah Tikva, , Israel

Site Status

Tel Aviv Medical Center

Tel Aviv, , Israel

Site Status

Azienda Ospedaliero-Universitaria Policlinico Di Modena

Modena, , Italy

Site Status

AORN dei Colli Monaldi

Napoli, , Italy

Site Status

National Institute for Infectious Diseases L. Spallanzani, IRCCS

Rome, , Italy

Site Status

"Spitalul Clinic de Urgenta Bucuresti. Popular unoficial name ""Floreasca "" Hospital"

Bucharest, , Romania

Site Status

National Institute for Infectious Diseases Prof Dr Matei Bals

Bucharest, , Romania

Site Status

Infectious Diseases Hospital Sfanta Parascheva Iasi

Iași, , Romania

Site Status

Hospital Universitari de Bellvitge

L'Hospitalet Del Llobregat, Barcelona, Spain

Site Status

Hospital Universitario 12 de Octubre

Madrid, , Spain

Site Status

Hospital Universitario Virgen Macarena

Seville, , Spain

Site Status

Ankara Numune Egitim ve Arastırma Hastanesi

Ankara, , Turkey (Türkiye)

Site Status

Istanbul University Cerrahpasa Medical School

Istanbul, , Turkey (Türkiye)

Site Status

Countries

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Bulgaria Greece Hungary Israel Italy Romania Spain Turkey (Türkiye)

References

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Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A Review of Ten Years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel). 2013 Nov 1;6(11):1335-46. doi: 10.3390/ph6111335.

Reference Type BACKGROUND
PMID: 24287460 (View on PubMed)

Hoban DJ, Lascols C, Nicolle LE, Badal R, Bouchillon S, Hackel M, Hawser S. Antimicrobial susceptibility of Enterobacteriaceae, including molecular characterization of extended-spectrum beta-lactamase-producing species, in urinary tract isolates from hospitalized patients in North America and Europe: results from the SMART study 2009-2010. Diagn Microbiol Infect Dis. 2012 Sep;74(1):62-7. doi: 10.1016/j.diagmicrobio.2012.05.024. Epub 2012 Jul 2.

Reference Type BACKGROUND
PMID: 22763019 (View on PubMed)

Yang YS, Ku CH, Lin JC, Shang ST, Chiu CH, Yeh KM, Lin CC, Chang FY. Impact of Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae on the outcome of community-onset bacteremic urinary tract infections. J Microbiol Immunol Infect. 2010 Jun;43(3):194-9. doi: 10.1016/S1684-1182(10)60031-X.

Reference Type BACKGROUND
PMID: 21291846 (View on PubMed)

Ha YE, Kang CI, Cha MK, Park SY, Wi YM, Chung DR, Peck KR, Lee NY, Song JH. Epidemiology and clinical outcomes of bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli in patients with cancer. Int J Antimicrob Agents. 2013 Nov;42(5):403-9. doi: 10.1016/j.ijantimicag.2013.07.018. Epub 2013 Sep 7.

Reference Type BACKGROUND
PMID: 24071027 (View on PubMed)

Trecarichi EM, Tumbarello M. Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis. 2014 Apr;27(2):200-10. doi: 10.1097/QCO.0000000000000038.

Reference Type BACKGROUND
PMID: 24573013 (View on PubMed)

Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, Dodek P, Wood G, Kumar A, Simon D, Peters C, Ahsan M, Chateau D; Cooperative Antimicrobial Therapy of Septic Shock Database Research Group. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009 Nov;136(5):1237-1248. doi: 10.1378/chest.09-0087. Epub 2009 Aug 20.

Reference Type BACKGROUND
PMID: 19696123 (View on PubMed)

Spoorenberg V, Hulscher ME, Akkermans RP, Prins JM, Geerlings SE. Appropriate antibiotic use for patients with urinary tract infections reduces length of hospital stay. Clin Infect Dis. 2014 Jan;58(2):164-9. doi: 10.1093/cid/cit688. Epub 2013 Oct 24.

Reference Type BACKGROUND
PMID: 24158412 (View on PubMed)

Levison ME, Kaye D. Treatment of complicated urinary tract infections with an emphasis on drug-resistant gram-negative uropathogens. Curr Infect Dis Rep. 2013 Apr;15(2):109-15. doi: 10.1007/s11908-013-0315-7.

Reference Type BACKGROUND
PMID: 23378123 (View on PubMed)

Nicolle LE. A practical guide to the management of complicated urinary tract infection. Drugs. 1997 Apr;53(4):583-92. doi: 10.2165/00003495-199753040-00004.

Reference Type BACKGROUND
PMID: 9098661 (View on PubMed)

Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002 Jul 8;113 Suppl 1A:5S-13S. doi: 10.1016/s0002-9343(02)01054-9.

Reference Type BACKGROUND
PMID: 12113866 (View on PubMed)

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8.

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PMID: 3558716 (View on PubMed)

Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of chemotherapeutic agents. Edited by MacLeod CM. New York: Columbia University Press; 1949:191-205.

Reference Type BACKGROUND

Barber J, Thompson S. Multiple regression of cost data: use of generalised linear models. J Health Serv Res Policy. 2004 Oct;9(4):197-204. doi: 10.1258/1355819042250249.

Reference Type BACKGROUND
PMID: 15509405 (View on PubMed)

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x. Epub 2011 Jul 27.

Reference Type BACKGROUND
PMID: 21793988 (View on PubMed)

Shaw E, Addy I, Stoddart M, Vank C, Grier S, Wiegand I, Leibovici L, Eliakim-Raz N, Vallejo-Torres L, Morris S, MacGowan A, Carratala J, Pujol M; COMBACTE-MAGNET Consortium. Retrospective observational study to assess the clinical management and outcomes of hospitalised patients with complicated urinary tract infection in countries with high prevalence of multidrug resistant Gram-negative bacteria (RESCUING). BMJ Open. 2016 Jul 29;6(7):e011500. doi: 10.1136/bmjopen-2016-011500.

Reference Type DERIVED
PMID: 27473949 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

http://www.efsa.europa.eu/en/efsajournal/pub/3590

The European Union Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2012

http://www.fda.gov/downloads/Drugs/Guidances/ucm070981.pdf

Complicated Urinary Tract Infections: Developing Drugs for Treatment. Guidance for Industry (2015). U.S. Department of Health and Human Services, Food and Drug Administration Center for Drug Evaluation and Research (CDER).

http://icd9data.com/2015/volume1/580-629/default.htm

International Classification of Diseases ICD-9 Data.

http://apps.who.int/classifications/icd10/browse/2015/en

International Statistical Classification of diseases and related Health Problems 10th Revision. ICD-10. Version 2015.

http://umm.edu/health/medical/reports/articles/urinary-tract-infection

University of Maryland Medical Center. Urinary tract Infection

http://eur-lex.europa.eu/legal-content/GA/ALL/?uri=OJ:L:1995:281:TOC

Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data

Other Identifiers

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PR 223/15

Identifier Type: -

Identifier Source: org_study_id

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