Vancomycin and Negative Pressure Therapy for Post-sternotomy Deep Sternal Wound Infection

NCT ID: NCT06506032

Last Updated: 2024-07-22

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

10 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-07-30

Study Completion Date

2023-12-31

Brief Summary

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Only a limited number of studies have been published that monitored the penetration of antibiotics from blood into exudate in patients treated with negative pressure wound therapy (NPWT), and that evaluated the adequacy of current dosage regimens according to antibiotic tissue concentrations. A higher migration rate of several antibiotics (including vancomycin) to exudate has been reported in patients with skin ulcers, skin defects, burns, and traumatic wounds treated with NPWT compared to patients without NPWT.

In the present study, the investigators will evaluate the pharmacokinetic profile and wound penetration of vancomycin in open-heart surgery patients with post-sternotomy deep sternal wound infection receiving NPWT.

Detailed Description

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For this prospective observational study, consecutive patients treated with NPWT for post-sternotomy deep sternal wound infection (DSWI) will be enrolled. On the first day of the study, serum and exudate samples will be synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3, and 6 hours after vancomycin administration. On the following three consecutive days, additional samples will be collected, only before vancomycin administration.

The ratio of average vancomycin concentration in wound exudate to serum will be observed for free (unbound) and for total (bound + unbound) concentration. The percentage of free vancomycin in wound exudate and in serum will be observed. The level of vancomycin wound penetration will be observed for three days. The total hospital stay in patients with DSWI versus those without DSWI will be recorded, together with the in-hospital or 90-day mortality, together with late DSWI recurrence. All-cause mortality will be analyzed during a median follow-up of 2.5 years.

Conditions

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Post-Sternotomy Deep Sternal Wound Infection

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients treated with NPWT with DSWI

Patients with deep sternal wound infection were enrolled in this study group.

Intravenous Vancomycin administration

Intervention Type DRUG

Vancomycin was administered to the patients at the discretion of the physician

Patients without DSWI after cardiac surgery

Patients without deep sternal wound infection after cardiac surgery were enrolled in this study group.

Standard postoperative therapy

Intervention Type OTHER

The patients received standard postoperative therapy

Interventions

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Intravenous Vancomycin administration

Vancomycin was administered to the patients at the discretion of the physician

Intervention Type DRUG

Standard postoperative therapy

The patients received standard postoperative therapy

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* age ≥ 18 years
* clinical and laboratory signs of significant infection
* indication for NPWT with concomitant antibiotic therapy

Exclusion Criteria

\- none
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Ostrava

OTHER

Sponsor Role collaborator

Masaryk University

OTHER

Sponsor Role collaborator

Masaryk Memorial Cancer Institute

OTHER

Sponsor Role collaborator

Technical University of Ostrava

UNKNOWN

Sponsor Role collaborator

University Hospital Ostrava

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Martin Kolek, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital Ostrava

Locations

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University of Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

Technical University of Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

University Hospital Ostrava

Ostrava, Moravian-Silesian Region, Czechia

Site Status

Masaryk University

Brno, South Moravian, Czechia

Site Status

Masaryk Memorial Cancer Institute

Brno, South Moravian, Czechia

Site Status

Countries

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Czechia

References

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Perezgrovas-Olaria R, Audisio K, Cancelli G, Rahouma M, Ibrahim M, Soletti GJ, Chadow D, Demetres M, Girardi LN, Gaudino M. Deep Sternal Wound Infection and Mortality in Cardiac Surgery: A Meta-analysis. Ann Thorac Surg. 2023 Jan;115(1):272-280. doi: 10.1016/j.athoracsur.2022.04.054. Epub 2022 May 23.

Reference Type BACKGROUND
PMID: 35618048 (View on PubMed)

Baillot R, Cloutier D, Montalin L, Cote L, Lellouche F, Houde C, Gaudreau G, Voisine P. Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies. Eur J Cardiothorac Surg. 2010 Apr;37(4):880-7. doi: 10.1016/j.ejcts.2009.09.023. Epub 2009 Oct 31.

Reference Type BACKGROUND
PMID: 19880326 (View on PubMed)

Polykandriotis E, Horch RE, Jost M, Arkudas A, Kees F, Schmitz M. Can systemically administered antibiotics be detected in wound tissues and surfaces under negative pressure wound therapy? Int Wound J. 2019 Apr;16(2):503-510. doi: 10.1111/iwj.13063. Epub 2019 Jan 3.

Reference Type BACKGROUND
PMID: 30604928 (View on PubMed)

Ida Y, Matsumura H, Onishi M, Ono S, Imai R, Watanabe K. Measurement of vancomycin hydrochloride concentration in the exudate from wounds receiving negative pressure wound therapy: a pilot study. Int Wound J. 2016 Apr;13(2):204-8. doi: 10.1111/iwj.12260. Epub 2014 Mar 28.

Reference Type BACKGROUND
PMID: 24674131 (View on PubMed)

Rowan MP, Niece KL, Rizzo JA, Akers KS. Wound Penetration of Cefazolin, Ciprofloxacin, Piperacillin, Tazobactam, and Vancomycin During Negative Pressure Wound Therapy. Adv Wound Care (New Rochelle). 2017 Feb 1;6(2):55-62. doi: 10.1089/wound.2016.0698.

Reference Type BACKGROUND
PMID: 28224048 (View on PubMed)

Kolek M, Duricova J, Brozmanova H, Sistik P, Jurica J, Kankova K, Motyka O, Kacirova I. Vancomycin wound penetration in open-heart surgery patients receiving negative pressure wound therapy for deep sternal wound infection. Ann Med. 2025 Dec;57(1):2444544. doi: 10.1080/07853890.2024.2444544. Epub 2024 Dec 23.

Reference Type DERIVED
PMID: 39711425 (View on PubMed)

Other Identifiers

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06/RVO-FNOs/2021

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

KCH-24-DSWI-vanko

Identifier Type: -

Identifier Source: org_study_id

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