CTTI Risk Factors for HABP/VABP Study

NCT ID: NCT02689531

Last Updated: 2023-06-15

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

Total Enrollment

7530 participants

Study Classification

OBSERVATIONAL

Study Start Date

2016-02-29

Study Completion Date

2018-02-28

Brief Summary

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The purpose of this study is to better define the intensive care unit population at highest risk for developing Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia (HABP/VABP).

Detailed Description

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This is a prospective, multi-center, observational study of adult patients (≥18 years old) admitted to ICUs. Generally, all patients admitted to the ICU for any indication will be considered at risk for developing HABP/VABP. A subset of the at-risk patients treated with select respiratory modalities for at least 12 hours will be considered high risk for the development of HABP/VABP, will have baseline data collected, and will be screened daily for antibiotic treatment for suspected pneumonia. Patients not meeting high-risk criteria, "other-ICU patients", will be screened twice weekly for antibiotic treatment for suspected pneumonia.

Once a high-risk subject or other-ICU patient is treated with antibiotics for either a lower respiratory tract infection (LRTI) or undifferentiated sepsis, additional clinical information will be recorded from the subject's medical record. All subjects treated with antibiotics for either indication will subsequently be screened for the development of pneumonia, as defined by the FDA draft guidance document for drug development in HABP/VABP. Subjects who meet the FDA draft guidance definition of pneumonia will have vitals and physiologic data collected and will be followed for 4 days after pneumonia is diagnosed to capture the results of any microbiologic testing and changes to initial antibiotic therapy.

Conditions

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Pneumonia, Ventilator-Associated Pneumonia, Bacterial Pneumonia, Hospital-Acquired

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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High-Risk (Adult =>18 years old)

Treated with one or more of the following respiratory modalities for at least 12 continuous hours, either currently or within the prior 7 days:

* Invasive mechanical ventilation
* Noninvasive ventilation (BiPAP or CPAP for any indication other than obstructive sleep apnea)
* High-flow, supplemental oxygen therapy via nasal cannula. Only include systems that using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM.
* High flow supplemental oxygen therapy delivering at least 50% FiO2 via aerosol facemask or tracheostomy collar (mask). Only include systems using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM.
* Supplemental oxygen therapy delivered via either partial or non-rebreather face mask

No interventions assigned to this group

Other-ICU/Standard Risk

Patients do not fulfill high-risk criteria, but, are receiving an antibiotic for treatment of lower respiratory tract infection or undifferentiated sepsis.

No interventions assigned to this group

High-Risk (Pediatric ≥120 days old and <18 years old)

Currently treated with one or more of the following respiratory modalities for at least 24 hours:

* Invasive mechanical ventilation via endotracheal intubation
* New initiation of mechanical ventilation, BiPAP or CPAP via tracheostomy
* Noninvasive ventilation (BiPAP or CPAP for any indication other than obstructive sleep apnea)
* High-flow, supplemental oxygen therapy delivering at least 1.5LMP with 100% FiO2 via nasal cannula when delivered using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM
* High flow supplemental oxygen therapy delivering at least 50% FiO2 via aerosol facemask or tracheostomy collar (mask) when delivered using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM
* Supplemental oxygen therapy delivered via either partial or non-rebreather face mask

No interventions assigned to this group

High-Risk (Pediatric <120 days old)

Currently treated with mechanical ventilation via endotracheal intubation for at least 5 days

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Admission to participating ICU
* Hospitalized for \>48 hours or admitted \<7 days after discharge from an inpatient acute or chronic care facility

High-Risk Inclusion (Adult arm =\> 18 years old):

Treated with one or more of the following respiratory modalities for at least 12 hours, either currently or within the prior 7 days:

* Invasive mechanical ventilation
* Noninvasive ventilation (BiPAP or CPAP for any indication other than obstructive sleep apnea)
* High-flow, supplemental oxygen therapy via nasal cannula. Only include systems that using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM.
* High flow supplemental oxygen therapy delivering at least 50% FiO2 via aerosol facemask or tracheostomy collar (mask). Only include systems using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM.
* Supplemental oxygen therapy delivered via either partial or non-rebreather face mask

Other-ICU Inclusion(Adult arm =\> 18 years old):

All patients who meet ICU and time-frame eligibility criteria, but do not fulfill high-risk criteria, and are receiving an antibiotic for treatment of LRTI or undifferentiated sepsis.


* \< 18 years old
* Admission to participating ICU or intermediate care unit
* Hospitalized for \>48 hours or admitted \<7 days after discharge from an inpatient acute or chronic care facility Note: Children and infants with pulmonary and cardiac anomalies are eligible to participate.

High-Risk Inclusion (Pediatric Arm: \< 18 years old)

Subjects ≥120 days old and \<18 years old:

Currently treated with one or more of the following respiratory modalities for at least 24 hours:

* Invasive mechanical ventilation via endotracheal intubation
* New initiation of mechanical ventilation, BiPAP or CPAP via tracheostomy
* Noninvasive ventilation (BiPAP or CPAP for any indication other than obstructive sleep apnea)
* High-flow, supplemental oxygen therapy delivering at least 1.5LMP with 100% FiO2 via nasal cannula when delivered using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM
* High flow supplemental oxygen therapy delivering at least 50% FiO2 via aerosol facemask or tracheostomy collar (mask) when delivered using an air/oxygen blender capable of delivering a precise FiO2 level, not just a flow in LPM
* Supplemental oxygen therapy delivered via either partial or non-rebreather face mask

Subjects \<120 days old:

Currently treated with mechanical ventilation via endotracheal intubation for at least 5 days

Standard-Risk Inclusion (Pediatric Arm: \< 18 years old) All patients who meet pediatric eligibility criteria, but do not fulfill high-risk criteria, and are receiving an antibiotic for treatment of LRTI or undifferentiated sepsis.

Exclusion Criteria

* Age \<18 years old
* Pregnancy (current) or breastfeeding
* Lung cancer or another malignancy metastatic to the lungs (currently receiving treatment)
* Patient previously enrolled and treated for suspected HABP or VABP (More than CRF Part 1 was previously completed)
* Patient is on comfort measures (e.g. would not receive antibiotics)


* Known pregnancy (current) or breastfeeding
* Lung cancer or another malignancy metastatic to the lungs (currently receiving treatment)
* Patient previously enrolled and treated for suspected HABP or VABP (More than Pediatric CRF Part 1 was previously completed)
* Patient is on comfort measures (e.g. would not receive antibiotics)
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Clinical Trials Transformation Initiative

OTHER

Sponsor Role collaborator

Food and Drug Administration (FDA)

FED

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Duke University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vance G Fowler, MD, MHS

Role: PRINCIPAL_INVESTIGATOR

Duke University

Locations

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Birmingham, Alabama, United States

Site Status

Los Angeles, California, United States

Site Status

Chicago, Illinois, United States

Site Status

Louisville, Kentucky, United States

Site Status

New Orleans, Louisiana, United States

Site Status

Detroit, Michigan, United States

Site Status

Royal Oak, Michigan, United States

Site Status

St Louis, Missouri, United States

Site Status

Rochester, New York, United States

Site Status

Durham, North Carolina, United States

Site Status

Cleveland, Ohio, United States

Site Status

Philadelphia, Pennsylvania, United States

Site Status

Pittsburgh, Pennsylvania, United States

Site Status

Charleston, South Carolina, United States

Site Status

Nashville, Tennessee, United States

Site Status

Countries

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United States

References

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Bergin SP, Coles A, Calvert SB, Farley J, Powers JH, Zervos MJ, Sims M, Kollef MH, Durkin MJ, Kabchi BA, Donnelly HK, Bardossy AC, Greenshields C, Rubin D, Sun JL, Chiswell K, Santiago J, Gu P, Tenaerts P, Fowler VG Jr, Holland TL. PROPHETIC: Prospective Identification of Pneumonia in Hospitalized Patients in the ICU. Chest. 2020 Dec;158(6):2370-2380. doi: 10.1016/j.chest.2020.06.034. Epub 2020 Jun 29.

Reference Type RESULT
PMID: 32615191 (View on PubMed)

Bergin SP, Calvert SB, Farley J, Sun JL, Chiswell K, Dieperink W, Kluytmans J, Lopez-Delgado JC, Leon-Lopez R, Zervos MJ, Kollef MH, Sims M, Kabchi BA, Rubin D, Santiago J, Natarajan M, Tenaerts P, Fowler VG, Holland TL, Bonten MJ, Hullegie SJ. PROPHETIC EU: Prospective Identification of Pneumonia in Hospitalized Patients in the Intensive Care Unit in European and United States Cohorts. Open Forum Infect Dis. 2022 May 9;9(7):ofac231. doi: 10.1093/ofid/ofac231. eCollection 2022 Jul.

Reference Type RESULT
PMID: 35836748 (View on PubMed)

Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, Agarwal S, Bressler AM, Gao J, Spears T, Benjamin DK Jr, Smith PB, Bradley JS; Best Pharmaceuticals for Children Act-Pediatric Trials Network Steering Committee and the Clinical Trials Transformation Initiative. Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study. Pediatr Infect Dis J. 2020 Aug;39(8):658-664. doi: 10.1097/INF.0000000000002642.

Reference Type RESULT
PMID: 32150005 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Study Documents

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Document Type: Individual Participant Data Set

View Document

Other Identifiers

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Pro00068313

Identifier Type: -

Identifier Source: org_study_id

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