Effect of Single vs Multiple Prophylactic Antibiotic Doses on PJI Following Primary THA in Patients With a Fracture

NCT ID: NCT05530174

Last Updated: 2025-03-24

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

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

2000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-01

Study Completion Date

2025-04-01

Brief Summary

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Aim: To compare the effect of one single dose versus multiple doses of prophylactic antibiotics administered within 24 hours, on the development of PJI after surgery in patients undergoing primary THA due to an acute fracture or sequelae of proximal femoral or acetabular fractures.

The study is designed as a cross-over, cluster randomized, non-inferiority trial. All Danish orthopedic surgery departments performing primary THA with the majority being within inclusion criteria will be involved: Based on national quality databases, two-year cohorts of approximately 2,000 primary THAs due to a fracture or sequelae to a fracture, conducted at all public and private orthopedic departments in Denmark, this includes 36 sites corresponding to a total of 39 departments.

Detailed Description

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The outcome measures will be extracted from the following national databases: The Civil Registration System (CRS), The Danish Hip Arthroplasty Register (DHR), The Danish National Patient Registry (DNRP), The Hospital Acquired Infections Database (HAIBA), The Danish National Prescription Database (NPR), Statistics Denmark and Danish Agency for Labour Market and Recruitment registry (STAR).

Details regarding the Arms and Interventions:

The preoperative dose of antibiotic must be administered prior to surgical incision and in cases of delay with regards to planned surgical incision:

Dicloxacillin/Cloxacillin: If the preoperative antibiotic dose is administered \>60 minutes prior to surgical incision, the initial dose must be repeated.

Cefuroxime: If the preoperative antibiotic dose is administered \>90 minutes prior to surgical incision, the initial dose must be repeated.

Treatment A, Single-dose practice:

For patients ≥ 120 kg:

One preoperative single dose of either Dicloxacillin/Cloxacillin 3g OR Cefuroxime 3g administered intravenously prior to surgical incision.

In cases of cephalosporin allergy or general beta lactam allergy one preoperative single dose of Clindamycin 900mg administered intravenously, prior to surgical incision, regardless of weight.

Treatment B, Multiple-dose practice:

For patients ≥ 120 kg:

One preoperative single dose of either Dicloxacillin/Cloxacillin 3g OR Cefuroxime 3g administered intravenously prior to surgical incision, followed by 3 postoperative doses of Dicloxacillin/Cloxacillin 2g x 3 OR cefuroxime 1.5g x 3, administered within 24 hours after the preoperative dose, corresponding to 6, 12 and 18 hours postoperatively.

After the first postoperative dose, the remaining doses may be administered perorally for pragmatic reasons.

Dicloxacillin p.o. 1g, 12 and 18 hours postoperatively. OR Amoxicillin and clavulanic acid p.o. 875mg/125\*mg, 12 and 18 hours postoperatively.

\*If the center or region does not have access to amoxicillin and clavulanic acid 875/125mg a dose of 1g / 125mg (this means amoxicillin 500mg + amoxicillin and clavulanic acid 500mg/125 mg) may be administered.

In cases of cephalosporin allergy or general beta lactam allergy one preoperative single dose of Clindamycin 900mg administered intravenously, prior to surgical incision, regardless of weight, followed by 2 postoperative doses corresponding to:

For patients \<120kg: 300mg, 8 and 16 hours postoperatively. For patients ≥ 120kg: 600mg, 8 and 16 hours postoperatively. The same doses apply in cases of transmission to peroral antibiotics.

Implementation: The senior biostatistician is responsible for the randomization process of the centers. Each center will be allocated a code by the senior biostatistician responsible and reported to a central database. The randomization and allocation procedure will be known for the given year conditioning the given center.

Ethics and Dissemination: This trial has been approved by the Regional Ethical Committee (VEK) (21069108) and The Danish Medicines Agency (2021091723) without imposing an obligation to notify.

Conditions

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Fracture of Hip Total Hip Arthroplasty Prosthetic-joint Infection Fracture Acetabular

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

The Pro-Hip-Quality Trial is a Cluster Randomized Trial with an embedded Cross-Over Design where each clinical center (C: 1, 2, 3, …., 36 individual sites) will be running a specific intervention (i.e. single- or multiple-dose antibiotics) throughout 12 months, and the subsequent year the clinical department will automatically switch to the opposite intervention (i.e. multiple- or single-dose antibiotics).
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Blinding will not be applicable, because it is considered infeasible to expose participants and clinical personnel to this in either of the groups since any specific clinic will follow their allocated specific (single- or multiple-dose) routine during an entire 1-year period and their routine treatment of any complication (before switching).

Study Groups

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Treatment A, Single-dose practice

One preoperative single dose of either Dicloxacillin/Cloxacillin 2g OR Cefuroxime 1.5g administered intravenously prior to surgical incision.

As the study is a non-inferiority trial, we have chosen the Experimental design category.

Group Type EXPERIMENTAL

Antibiotic dosage practice

Intervention Type OTHER

Patient inclusion starts day one, cross-over of departments from treatment A (single-dose) to B (multiple-dose) or vice versa after one year and end of inclusion happens after 2 years.

All centers in Denmark use either Cloxacillin/Dicloxacillin, Cefuroxime or both drugs as standard prophylactic antibiotic practice for THA. In cases of cephalosporin allergy or general beta lactam allergy, the antibiotic clindamycin may be administered.

In this trial, patients will be administered the standard prophylactic antibiotic practice of either single-dose (A) or multiple-doses (B) of antibiotics administered at each respective cluster that respective year. Both practices of dose administration for antibiotic prophylaxis (i.e. single- or multiple-dose) follow current standards of treatment and are based on present clinical practice guidelines.

Treatment B, Multiple-dose practice

One preoperative dose of either Dicloxacillin/Cloxacillin 2g OR Cefuroxime 1.5g administered intravenously prior to surgical incision followed by 3 postoperative doses of Dicloxacillin/Cloxacillin 1g x 3 OR Cefuroxime 750mg x 3 within 24 hours after the preoperative dose.

Group Type ACTIVE_COMPARATOR

Antibiotic dosage practice

Intervention Type OTHER

Patient inclusion starts day one, cross-over of departments from treatment A (single-dose) to B (multiple-dose) or vice versa after one year and end of inclusion happens after 2 years.

All centers in Denmark use either Cloxacillin/Dicloxacillin, Cefuroxime or both drugs as standard prophylactic antibiotic practice for THA. In cases of cephalosporin allergy or general beta lactam allergy, the antibiotic clindamycin may be administered.

In this trial, patients will be administered the standard prophylactic antibiotic practice of either single-dose (A) or multiple-doses (B) of antibiotics administered at each respective cluster that respective year. Both practices of dose administration for antibiotic prophylaxis (i.e. single- or multiple-dose) follow current standards of treatment and are based on present clinical practice guidelines.

Interventions

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Antibiotic dosage practice

Patient inclusion starts day one, cross-over of departments from treatment A (single-dose) to B (multiple-dose) or vice versa after one year and end of inclusion happens after 2 years.

All centers in Denmark use either Cloxacillin/Dicloxacillin, Cefuroxime or both drugs as standard prophylactic antibiotic practice for THA. In cases of cephalosporin allergy or general beta lactam allergy, the antibiotic clindamycin may be administered.

In this trial, patients will be administered the standard prophylactic antibiotic practice of either single-dose (A) or multiple-doses (B) of antibiotics administered at each respective cluster that respective year. Both practices of dose administration for antibiotic prophylaxis (i.e. single- or multiple-dose) follow current standards of treatment and are based on present clinical practice guidelines.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* All patients receiving a primary Total Hip Arthroplasty (THA) due to an acute- or sequelae of proximal femoral or acetabular fractures

Exclusion Criteria

* Patients receiving a primary THA due to bone tumor or metastasis
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Copenhagen

OTHER

Sponsor Role collaborator

University Hospital Bispebjerg and Frederiksberg

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role collaborator

Aarhus University Hospital

OTHER

Sponsor Role collaborator

University of Aarhus

OTHER

Sponsor Role collaborator

Sygehus Lillebaelt

OTHER

Sponsor Role collaborator

Soren Overgaard

OTHER

Sponsor Role lead

Responsible Party

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Soren Overgaard

Clinical Professor, DMSc

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Armita A Abedi, MD

Role: PRINCIPAL_INVESTIGATOR

Copenhagen University Hospital, Bispebjerg Department of Orthopedic Surgery and Traumatology

Locations

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Department of Orthopedic Surgery, Aabenraa and Sønderborg, Hospital of Southern Jutland

Aabenraa, , Denmark

Site Status

Capio Private Hospital, Aalborg

Aalborg, , Denmark

Site Status

Department of Orthopedic Surgery, Aalborg, Aalborg University Hospital

Aalborg, , Denmark

Site Status

Aleris Private Hospital, Aarhus

Aarhus, , Denmark

Site Status

Deaprtment of Orthopaedic Surgery, Aarhus University Hospital

Aarhus, , Denmark

Site Status

Capio Private Hospital, Aarhus

Aarhus C, , Denmark

Site Status

Capio Private Hospital, Gildhøj

Brøndby, , Denmark

Site Status

Department of Orthopedic Surgery and Traumatology, Bispebjerg, Copenhagen University Hospital - Bispebjerg and Frederiksberg

Copenhagen NV, , Denmark

Site Status

Adeas Private Hospital, Parken

Copenhagen Ø, , Denmark

Site Status

Department of Orthopedic Surgery, Esbjerg, Hospital of South West Jutland

Esbjerg, , Denmark

Site Status

Department of Orthopedic Surgery, Farsø, Aalborg University Hospital

Farsø, , Denmark

Site Status

CPH Private Hospital

Farum, , Denmark

Site Status

Department of Orthopedic Surgery, Frederikshavn, Aalborg University Hospital

Frederikshavn, , Denmark

Site Status

Department of Orthopedic Surgery, Grindsted, Hospital of South West Jutland

Grindsted, , Denmark

Site Status

Capio Private Hospital, Hellerup and Odense

Hellerup, , Denmark

Site Status

Department of Orthopaedic Surgery, Gentofte, Copenhagen University Hospital - Herlev and Gentofte

Hellerup, , Denmark

Site Status

Department of Orthopaedic Surgery, Herlev, Copenhagen University Hospital - Herlev and Gentofte

Herlev, , Denmark

Site Status

Department of Orthopedic Surgery, Gødstrup Regional Hospital

Herning, , Denmark

Site Status

Department of Orthopedic Surgery, Hillerød, Copenhagen University Hospital - North Zealand

Hillerød, , Denmark

Site Status

Department of Orthopedic Surgery, Copenhagen University Hospital - Holbæk

Holbæk, , Denmark

Site Status

Department of Orthopedic Surgery, Horsens Regional Hospital, Denmark

Horsens, , Denmark

Site Status

Department of Orthopedic Surgery, Hvidovre, Copenhagen University Hospital - Amager and Hvidovre

Hvidovre, , Denmark

Site Status

Acure Private Hospital

Kongens Lyngby, , Denmark

Site Status

Kollund Private Hospital, Kollund

Kruså, , Denmark

Site Status

Department of Orthopedic Surgery, Zealand University Hospital, Køge

Køge, , Denmark

Site Status

Department of Orthopedic Surgery, Copenahegn University Hospital - Nykøbing F.

Nykøbing Falster, , Denmark

Site Status

Department for Planned Orthopaedic Surgery, Næstved, Copenhagen University Hospital - Næstved, Slagelse and Ringsted

Næstved, , Denmark

Site Status

Department of Orthopedic Surgery and Traumatology, Odense University Hospital and Svendborg Hospital

Odense, , Denmark

Site Status

Deparmtent of Orthopedic Surgery, Randers Regional Hospital

Randers, , Denmark

Site Status

Aleris Private Hospital, Ringsted

Ringsted, , Denmark

Site Status

Department of Surgery, Copenhagen University Hospital - Bornholm

Rønne, , Denmark

Site Status

Center for Planned Surgery, Silkeborg Regional Hospital

Silkeborg, , Denmark

Site Status

Aleris Private Hospital, Søborg

Søborg, , Denmark

Site Status

Department of Orthopedics, Lillebaelt Hospital, Vejle

Vejle, , Denmark

Site Status

Mølholm Private Hospital, Vejle

Vejle, , Denmark

Site Status

Deparmtent of Orthopedic Sugery, Viborg Regional Hospital

Viborg, , Denmark

Site Status

Countries

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Denmark

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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ProHipQ Fracture

Identifier Type: -

Identifier Source: org_study_id

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