Antibiotic Prophylaxis in Metabolic Bariatric Surgery

NCT ID: NCT06510452

Last Updated: 2024-07-31

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

3352 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-01

Study Completion Date

2026-04-01

Brief Summary

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SUMMARY Rationale: Prophylactic antibiotics in laparoscopic surgeries, including Metabolic Bariatric Surgery (MBS), are routinely provided to reduce postoperative infections, especially at wound incision sites. However, since incisional wound infections in laparoscopic MBS are rare and morbidity is very low, the benefit of antibiotic prophylaxis is questionable.

Objective: Evaluate the non-inferiority of omitting antibiotic prophylaxis in MBS. Compare postoperative outcomes between Group A (no antibiotics) and Group B (standard antibiotic care) to determine if omission increases complications, particularly wound infections.

Study Design: Randomized controlled trial (RCT), double-blind.

Study Population: Patients with obesity eligible for MBS.

Intervention:

* Group A (No Antibiotic Prophylaxis): Undergo MBS without antibiotics to test safety regarding postoperative complications, focusing on surgical site infections (SSIs).
* Group B (Standard Antibiotic Prophylaxis): Receive standard one-time antibiotics before incision.

Main Study Parameters/Endpoints: Compare the incidence of incisional and organ/space SSIs within six weeks post-surgery between Group A and Group B to determine if omitting antibiotics affects infection rates.

Detailed Description

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Nature and Extent of the Burden and Risks:

Rationale:

1. Cost-Effectiveness: Reducing antibiotic use could lower surgical costs.
2. Resource Utilization: Simplifying protocols save hospital resources.
3. Antibiotic Resistance: Reducing use helps combat resistant bacteria.
4. Adverse Reactions: Fewer antibiotics may reduce side effects.

Risk Assessment:

1. Increased Infection Rates: Monitor SSI and organ/space SSI rates closely.
2. Anastomotic Leaks and Reoperations: Assess the impact on leaks and operations.
3. Readmissions and Postoperative Interventions: Evaluate the effect on readmission and intervention rates.

Group Relatedness:

Comparing groups with and without antibiotics provides evi-dence-based insights into the safety of modifying standard practices to optimize health outcomes and resource use.

Conditions

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Antibiotic Reaction Wound Infection Superficial Wound Infection Deep Bariatric Surgery Candidate Complication,Postoperative

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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NACL0.9%

Group A will receive 100 ml NACL0.9% without any antibiotics in it.

Group Type EXPERIMENTAL

NACL 0.9% 100 ml

Intervention Type DRUG

receive 100 ml NACL0.9% without any antibiotics in it.

Cefazolin +Metronidazole

Group B will receive 2000 mg of Cefazolin and 500 mg of Metronidazole IV dissolved in 100 ml NACL0.9%. Both antibiotics will be administered at least 30 minutes before surgery to ensure adequate tissue concentrations at the time of incision.

Group Type ACTIVE_COMPARATOR

2000 mg of Cefazolin

Intervention Type DRUG

receive 2000 mg of Cefazolin and 500 mg of Metronidazole IV dissolved in 100 ml NACL0.9%.

500 mg of Metronidazole IV

Intervention Type DRUG

receive 2000 mg of Cefazolin and 500 mg of Metronidazole IV dissolved in 100 ml NACL0.9%.

Interventions

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2000 mg of Cefazolin

receive 2000 mg of Cefazolin and 500 mg of Metronidazole IV dissolved in 100 ml NACL0.9%.

Intervention Type DRUG

500 mg of Metronidazole IV

receive 2000 mg of Cefazolin and 500 mg of Metronidazole IV dissolved in 100 ml NACL0.9%.

Intervention Type DRUG

NACL 0.9% 100 ml

receive 100 ml NACL0.9% without any antibiotics in it.

Intervention Type DRUG

Other Intervention Names

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Kefzol Flagyl Saline

Eligibility Criteria

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Inclusion Criteria

° Patients must be older than 18 and meet the eligibility criteria for MBS as outlined by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) and the Dutch Federation of Medical Specialists for the surgical treatment of obesity.

Exclusion Criteria

* Patients undergoing immunotherapy or corticosteroid treatment for Crohn's disease or rheumatoid arthritis.
* Patients with a history of endocarditis require prophylactic antibiotics.
* Patients with known severe allergies to antibiotics.
* Patients with active infections or recently treated with antibiotics (within the last 30 days).
* Patients with compromised immune systems, including those with HIV/AIDS or undergoing chemotherapy.
* Patients with chronic liver or kidney disease.
* Patients with uncontrolled diabetes (HbA1c \> 9%).
* Patients with a history of previous metabolic bariatric surgery.
* Pregnant or breastfeeding women.
* Patients with any other medical condition that, in the opinion of the investigator, would compromise the patient's safety or the study's integrity.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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General Committee of Teaching Hospitals and Institutes, Egypt

OTHER_GOV

Sponsor Role lead

Responsible Party

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Mohamed Hany Ashour

head of bariatric surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Madina Women's Hospital

Alexandria, , Egypt

Site Status

WeightWorks clinics

Amersfoort, Utrecht, Netherlands

Site Status

Countries

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Egypt Netherlands

Facility Contacts

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Bart Torensma, MSc PhD

Role: primary

+31641389070

Frits Berends, MD, PhD

Role: backup

+31655100534

References

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CDC antimicrobial resistance. Available from: https://www.cdc.gov/drugresistance/about.html

Reference Type BACKGROUND

Aktas A, Kayaalp C, Gunes O, Kirkil C, Tardu A, Aydin MC, Bag YM, Cayci HM, Arslan U, Sumer F, Aygen E. Surgical Site Infections after Laparoscopic Bariatric Surgery: Is Routine Antibiotic Prophylaxis Required? Surg Infect (Larchmt). 2021 Sep;22(7):705-712. doi: 10.1089/sur.2020.426. Epub 2021 Jan 8.

Reference Type RESULT
PMID: 33416442 (View on PubMed)

Dang JT, Tran C, Switzer N, Delisle M, Laffin M, Madsen K, Birch DW, Karmali S. Predicting surgical site infections following laparoscopic bariatric surgery: development of the BariWound tool using the MBSAQIP database. Surg Endosc. 2020 Apr;34(4):1802-1811. doi: 10.1007/s00464-019-06932-6. Epub 2019 Jun 24.

Reference Type RESULT
PMID: 31236724 (View on PubMed)

Shope TR, Cooney RN, McLeod J, Miller CA, Haluck RS. Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg. 2003 Jun;13(3):355-9. doi: 10.1381/096089203765887651.

Reference Type RESULT
PMID: 12841893 (View on PubMed)

Alasfar F, Sabnis A, Liu R, Chand B. Reduction of circular stapler-related wound infection in patients undergoing laparoscopic Roux-en-Y gastric bypass, Cleveland clinic technique. Obes Surg. 2010 Feb;20(2):168-72. doi: 10.1007/s11695-008-9708-3. Epub 2008 Oct 7.

Reference Type RESULT
PMID: 18839083 (View on PubMed)

Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000 Oct;232(4):515-29. doi: 10.1097/00000658-200010000-00007.

Reference Type RESULT
PMID: 10998650 (View on PubMed)

Finks JF, Carlin A, Share D, O'Reilly A, Fan Z, Birkmeyer J, Birkmeyer N; Michigan Bariatric Surgery Collaborative from the Michigan Surgical Collaborative for Outcomes Research Evaluation. Effect of surgical techniques on clinical outcomes after laparoscopic gastric bypass--results from the Michigan Bariatric Surgery Collaborative. Surg Obes Relat Dis. 2011 May-Jun;7(3):284-9. doi: 10.1016/j.soard.2010.10.004. Epub 2010 Oct 16.

Reference Type RESULT
PMID: 21126927 (View on PubMed)

Mangram AJ, Horan TC, Pearson ML, Silver LC. Guideline for Prevention of Surgical Site Infection, 1999. 1999;27.

Reference Type RESULT

Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists (ASHP); Infectious Diseases Society of America (IDSA); Surgical Infection Society (SIS); Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt). 2013 Feb;14(1):73-156. doi: 10.1089/sur.2013.9999. Epub 2013 Mar 5. No abstract available.

Reference Type RESULT
PMID: 23461695 (View on PubMed)

Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, Nyquist AC, Saiman L, Yokoe DS, Maragakis LL, Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Sep;35 Suppl 2:S66-88. doi: 10.1017/s0899823x00193869. No abstract available.

Reference Type RESULT
PMID: 25376070 (View on PubMed)

De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Fruhbeck G, Sarwer DB, Suter M, Soricelli E, Bluher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016 Aug;26(8):1659-96. doi: 10.1007/s11695-016-2271-4. No abstract available.

Reference Type RESULT
PMID: 27412673 (View on PubMed)

Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023 Jan;33(1):3-14. doi: 10.1007/s11695-022-06332-1.

Reference Type RESULT
PMID: 36336720 (View on PubMed)

Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259-273. doi: 10.1016/j.anai.2010.08.002.

Reference Type RESULT
PMID: 20934625 (View on PubMed)

Jourdan A, Sangha B, Kim E, Nawaz S, Malik V, Vij R, Sekhsaria S. Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice. Allergy Asthma Clin Immunol. 2020 Jan 21;16:6. doi: 10.1186/s13223-020-0402-x. eCollection 2020.

Reference Type RESULT
PMID: 31993070 (View on PubMed)

WHO antimicrobial resistance. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

Reference Type RESULT

Mokrani D, Chommeloux J, Pineton de Chambrun M, Hekimian G, Luyt CE. Antibiotic stewardship in the ICU: time to shift into overdrive. Ann Intensive Care. 2023 May 6;13(1):39. doi: 10.1186/s13613-023-01134-9.

Reference Type RESULT
PMID: 37148398 (View on PubMed)

Other Identifiers

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AB-BAR-2024

Identifier Type: -

Identifier Source: org_study_id

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