Trial Outcomes & Findings for Efficacy of Betalactam Antibiotics in Prolonged Infusion Compared to Intermittent in Pediatric Patients With Sepsis (NCT NCT03019965)

NCT ID: NCT03019965

Last Updated: 2021-08-05

Results Overview

Resolution. Disappearance of all signs and symptoms related to the infection. Failure. Insufficient lessening of the signs and symptoms of infection to qualify as improvement, including death or indeterminate (no evaluation possible, for any reason).

Recruitment status

COMPLETED

Study phase

NA

Target enrollment

426 participants

Primary outcome timeframe

Number of participants with clinical response at 14 days after antibiotic cessation, up to an average of 28 days or the day of your discharge if this occurred before 14 days after antibiotic cessation.

Results posted on

2021-08-05

Participant Flow

the pre-specified intent was to only compare "Intermittent" and "Prolonged" Arm/Groups with the grouping of betalactam antibiotics (imipenem, meropenem and piperacillin/tazobactam)

Participant milestones

Participant milestones
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Overall Study
STARTED
211
215
Overall Study
COMPLETED
201
202
Overall Study
NOT COMPLETED
10
13

Reasons for withdrawal

Reasons for withdrawal
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Overall Study
Withdrawal by Subject
1
0
Overall Study
Protocol Violation
1
3
Overall Study
viral or fungal infection
3
4
Overall Study
acute liver failure in the first 24 hours of randomization
4
5
Overall Study
Physician Decision
1
1

Baseline Characteristics

Race and Ethnicity were not collected from any participant.

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
n=201 Participants
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
n=202 Participants
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Total
n=403 Participants
Total of all reporting groups
Age, Categorical
<=18 years
201 Participants
n=201 Participants
202 Participants
n=202 Participants
403 Participants
n=403 Participants
Age, Categorical
Between 18 and 65 years
0 Participants
n=201 Participants
0 Participants
n=202 Participants
0 Participants
n=403 Participants
Age, Categorical
>=65 years
0 Participants
n=201 Participants
0 Participants
n=202 Participants
0 Participants
n=403 Participants
Age, Continuous
6 years
n=201 Participants
6 years
n=202 Participants
6 years
n=403 Participants
Sex: Female, Male
Female
91 Participants
n=201 Participants
91 Participants
n=202 Participants
182 Participants
n=403 Participants
Sex: Female, Male
Male
110 Participants
n=201 Participants
111 Participants
n=202 Participants
221 Participants
n=403 Participants
Race and Ethnicity Not Collected
0 Participants
Race and Ethnicity were not collected from any participant.
Region of Enrollment
Mexico
201 participants
n=201 Participants
202 participants
n=202 Participants
403 participants
n=403 Participants
Comorbidity
196 Participants
n=201 Participants
187 Participants
n=202 Participants
383 Participants
n=403 Participants
Comorbid conditions
Neoplastic
125 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
133 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
258 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Gastrointestinal
20 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
15 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
35 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Neurological
8 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
11 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
19 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Neonatal
2 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
3 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
5 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Cardiovascular
15 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
8 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
23 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Respiratory
2 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
2 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
4 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Hematologic/immunologic
11 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
4 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
15 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Metabolic
1 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
1 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
2 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Renal
1 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
0 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
1 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Genetic
11 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
9 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
20 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Comorbid conditions
Stem cell transplant
0 Participants
n=196 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
1 Participants
n=187 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
1 Participants
n=383 Participants • Comorbidity only was in 196 patients in intermittent infusion group and 187 patients in prolonged infusion group.
Hospital stay prior to enrollment to the study protocol
113 Participants
n=201 Participants
122 Participants
n=202 Participants
235 Participants
n=403 Participants
septic shock at enrollment
49 Participants
n=201 Participants
61 Participants
n=202 Participants
110 Participants
n=403 Participants
B-lactam antibiotic
piperacillin/tazobactam
109 Participants
n=201 Participants
108 Participants
n=202 Participants
217 Participants
n=403 Participants
B-lactam antibiotic
imipenem
39 Participants
n=201 Participants
42 Participants
n=202 Participants
81 Participants
n=403 Participants
B-lactam antibiotic
meropenem
53 Participants
n=201 Participants
52 Participants
n=202 Participants
105 Participants
n=403 Participants
type of infection
febrile neutropenia
69 Participants
n=201 Participants
55 Participants
n=202 Participants
124 Participants
n=403 Participants
type of infection
intraabdominal
40 Participants
n=201 Participants
55 Participants
n=202 Participants
95 Participants
n=403 Participants
type of infection
respiratory tract
34 Participants
n=201 Participants
27 Participants
n=202 Participants
61 Participants
n=403 Participants
type of infection
bacteremia
30 Participants
n=201 Participants
35 Participants
n=202 Participants
65 Participants
n=403 Participants
type of infection
skin and soft tissue
11 Participants
n=201 Participants
10 Participants
n=202 Participants
21 Participants
n=403 Participants
type of infection
unknown
11 Participants
n=201 Participants
14 Participants
n=202 Participants
25 Participants
n=403 Participants
type of infection
urinary tract
6 Participants
n=201 Participants
6 Participants
n=202 Participants
12 Participants
n=403 Participants
Number of participants with organisms identified
75 Participants
n=201 Participants
86 Participants
n=202 Participants
161 Participants
n=403 Participants

PRIMARY outcome

Timeframe: Number of participants with clinical response at 14 days after antibiotic cessation, up to an average of 28 days or the day of your discharge if this occurred before 14 days after antibiotic cessation.

Population: The efficacy of the maneuver was evaluated by frequency of clinical response and calculation of the absolute risk reduction and the number needed to treat.

Resolution. Disappearance of all signs and symptoms related to the infection. Failure. Insufficient lessening of the signs and symptoms of infection to qualify as improvement, including death or indeterminate (no evaluation possible, for any reason).

Outcome measures

Outcome measures
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
n=201 Participants
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
n=202 Participants
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Number of Participants With Clinical Response
178 Participants
169 Participants

SECONDARY outcome

Timeframe: Number of participants with adverse events evaluated by an physician at the time of administration of antibiotics, up to an average to 24 hours after the study drug cessation.

Population: evaluation of the safety of the intervention with analysis of the frequency of adverse events by treatment group

Any harmful, undesirable, potentially serious and life threatening effects occurring during or after administration of the antibiotics proposed in this study (piperacillin / tazobactam, imipenem or meropenem), was evaluated as: none or adverse event classified according to the intensity of the clinical manifestation (severity) as: mild, moderate or severe and for each antibiotic.

Outcome measures

Outcome measures
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
n=201 Participants
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
n=202 Participants
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Number of Participants With Adverse Events
1 Participants
3 Participants

Adverse Events

Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem

Serious events: 0 serious events
Other events: 1 other events
Deaths: 17 deaths

Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem

Serious events: 0 serious events
Other events: 3 other events
Deaths: 19 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Intermittent. Piperacillin/Tazobactam, Imipenem, Meropenem
n=201 participants at risk
Piperacillin/tazobactam 300mg/kg/day, divided into 4 doses/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 30 minutes infusion every 6 hours. Intermittent Piperacillin/tazobactam: Piperacillin/tazobactam administered in 30 minutes infusion. Imipenem 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes infusion every 6 hours. Intermittent Imipenem: Imipenem administered in 60 minutes infusion. Meropenem 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 60 minutes every 8 hours. Intermittent Meropenem: Meropenem administered in 60 minutes infusion.
Prolonged Infusion. Continuous Piperacillin/Tazobactam, Extended Imipenem, Extended Meropenem
n=202 participants at risk
Piperacillin/tazobactam initial doses 75mg/kg in 30 minutes infusion, immediately thereafter continue 300mg/kg/day, diluted in 5% glucose solution, at a concentration of 50mg/ml, to be administered in 24 hours infusion every 24 hours, as determined by antibiotic stability at room temperature. Continuous Piperacillin/tazobactam: Piperacillin/tazobactam administered in 24 hours infusion. Imipenem initial doses 20mg/kg in 60 minutes infusion, immediately thereafter continue 80mg/kg/day, divided into 4 doses/day, diluted in 0.9% saline solution, at a concentration of 7mg/ml, to be administered in 6 hours infusion every 6 hours, as determined by antibiotic stability at room temperature. Extended Imipenem: Imipenem administered in 6 hours infusion. Meropenem initial doses 35mg/kg in 60 minutes infusion, immediately thereafter continue 100mg/kg/day, divided into 3 doses/day, diluted in 0.9% saline solution at a concentration of 7mg/ml, to be administered in 8 hours infusion every 8 hours, as determined by antibiotic stability at room temperature. Extended Meropenem: Meropenem administered in 8 hours infusion.
Gastrointestinal disorders
moderate adverse event
0.50%
1/201 • Number of events 1 • adverse events by the mode of administration: intermittent or prolonged, evaluated during the time of administration, up to an average 24 hours after administration of the antibiotics proposed.
pre-specified intent was to only compare "Intermittent" and "Prolonged" Arm/Groups with the grouping of antibiotics betalactam (imipenem, meropenem and piperacillin/tazobactam)
1.5%
3/202 • Number of events 3 • adverse events by the mode of administration: intermittent or prolonged, evaluated during the time of administration, up to an average 24 hours after administration of the antibiotics proposed.
pre-specified intent was to only compare "Intermittent" and "Prolonged" Arm/Groups with the grouping of antibiotics betalactam (imipenem, meropenem and piperacillin/tazobactam)

Additional Information

Dr. Yazmín Fuentes

CISMexico

Phone: 55276900

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place