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Staphylococcus Aureus InfectionTARGET IINCT04503252

Probability of Target Attainment With Standard Intermittent Bolus Administration of Cefazolin in Patients With Complicated Infections Caused by Staphylococcus Aureus

An observational study of Staphylococcus Aureus Infection, run by University Hospital, Basel, Switzerland at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Given the paucity of pharmacological data on cefazolin treatment of Methicillin-susceptible S. aureus (MSSA) complicated S. aureus infection (CSAI), the primary purpose of this study is to investigate the probability of pharmacological target attainment (in the blood and infected tissue) with standard intermittent… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Staphylococcus Aureus Infection
What is being tested?
Blood samples for the measurement of the concentration of cefazolin, S. aureus culture isolate and structured telephone interview
How many people
50 participants
Where
1 siteSwitzerland
Study dates
14 Jan 2020to 28 Mar 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Inpatients with CSAI fulfilling the inclusion criteria and admitted at the University Hospital Basel.

Who may be able to join

  • CSAI caused by MSSA. CSAI is defined as MSSA BSI with a positive follow-up blood culture result for MSSA or the presence of a site of infection remote from the primary focus caused by hematogenous seeding (e.g. endocarditis, vertebral osteomyelitis) or extension of the infection beyond the primary focus (e.g. septic thrombophlebitis or abscess); or deep-seated infections caused by MSSA (e.g. osteoarticular infections, deepseated abscesses).
  • Current or intended treatment with cefazolin

Who cannot join

  • Previous enrolment into the current study within 30 days
  • Hemodialysis (patients on hemofiltration are eligible)
  • Patients who are very likely to stop treatment with cefazolin in the next 48 hours as per treating physician (because of treatment failure, switch to oral medication, palliative care, allergy etc.) or who are very likely to be discharged in the next 48 hours as per treating physician.
  • Outpatients
  • Women who are pregnant (special pharmacokinetic)
  • Polymicrobial infection except concomitant isolation of a likely contaminant (e.g. Staphylococcus epidermidis or Propionibacterium acnes) or an anaerobic pathogen. If an additional pathogen is identified after inclusion of the patient into the study, the patient will remain in the study.
Show all 12Show fewer
  • Not-complicated S. aureus infections: non-bacteremic skin- and soft tissue or small Joint infections without deep-seated abscesses (as these patients will be quickly switched to oral antibiotics)
  • CSAI caused by methicillin-resistant S. aureus (MRSA)
  • Additional exclusion criteria for the sub-study investigating cefazolin concentrations in sweat:
  • Allergic to pilocarpine
  • Continuous oxygen therapy without the possibility to interrupt oxygen administration for 10min
  • Pacemaker

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • University Hospital Basel, Division of Internal Medicine

    Basel, 4031

Other trials in Switzerland

About this study

Official title: Probability of Target Attainment With Standard Intermittent Bolus Administration of Cefazolin in Patients With Complicated Infections Caused by Staphylococcus Aureus: A Prospective Single-center Cohort Study

Given the paucity of pharmacological data on cefazolin treatment of Methicillin-susceptible S. aureus (MSSA) complicated S. aureus infection (CSAI), the primary purpose of this study is to investigate the probability of pharmacological target attainment (in the blood and infected tissue) with standard intermittent bolus administration of cefazolin in patients with CSAI caused by MSSA by determining plasma concentrations of cefazolin and exact Minimum inhibitory concentration (MICs) of the causative MSSA strains in patients with various disease severities (e.g. critically ill vs. noncritically ill patients).

  • Sub-study quantitative measurement of Torque Teno virus (TTV): The primary purpose of this sub-study is to describe the viral kinetics of TTV in CSAI patients and to explore the association of TTV viremia with clinical outcomes and molecular markers of activation of the immune system.
  • Sub-study investigating antibiotic concentrations in sweat as a non-invasive therapeutic drug monitoring
Being tested
Blood samples for the measurement of the concentration of cefazolin, S. aureus culture isolate, structured telephone interview, Sub-study quantitative measurement of Torque Teno virus, Sub-study investigating cefazolin concentrations in sweat
Keywords
Bloodstream infection (BSI), Minimum inhibitory concentration (MIC), Methicillin-susceptible S. aureus (MSSA), Staphylococcus aureus (S. aureus), β-lactam antibiotics, flucloxacillin, cefazolin, pharmacological target attainment, Torque Teno virus (TTV), Therapeutic drug monitoring (TDM), antibiotic sweat concentrations, Complicated S. aureus infection (CSAI)
Medical subject headings
Staphylococcal Infections, Sepsis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Blood samples for the measurement of the concentration of cefazolinOther

    Blood samples for the measurement of the concentration of cefazolin will be collected on the 1st (mid-dose and trough sample), 3rd (mid-dose and trough sample),7th and 14th day (for both only trough sample) of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (usually within 4 weeks after inclusion; only in patients on outpatient continuous parenteral antibiotic treatment).

  • S. aureus culture isolateOther

    The S. aureus culture isolate will be subjected to exact cefazolin MIC determination and to measurement of the level of cefazolin tolerance.

  • structured telephone interviewOther

    Structured telephone interview for Patient follow- up after 30 days

  • Sub-study quantitative measurement of Torque Teno virusOther

    An additional EDTA sample will be drawn for quantitative polymerase chain reaction (PCR) of TTV DNA and analyses of cytokines and other parameters of the activation state of the immune system.

  • Sub-study investigating cefazolin concentrations in sweatOther

    For each visit of included patients, a sweat sample will be collected via a CE certified Macroduct Sweat Collector. Eccrine sweat glands of the lower forearms are stimulated by pilocarpine (a parasympathomimetic) as well as a local current for 5min. Sweat is subsequently collected by capillary containers during 30min and transferred to small tubes on dry ice. Sweat sample analysis is conducted using mass spectrometry.

Study groups in NCT04503252
Study groupRoleWhat they receive
Study population: patients with CSAI caused by MSSAInpatients with CSAI caused by MSSA treated or intended to receive cefazolin within the next 24-48 hours (at least 10 (maximum of 20) critically-ill patients, at least 10 (maximum of 20) patients with an estimated glomerular filtration rate of <60ml/min, at least 10 patients with BSI).
Receives: Other: Blood samples for the measurement of the concentration of cefazolin; Other: S. aureus culture isolate; Other: structured telephone interview
Sub-study: Torque Teno virus (TTV) viremiaTTV viral load may indicate the immunological status of the host. The TTV sub-study is to to describe the viral kinetics of TTV in CSAI patients.
Receives: Other: Blood samples for the measurement of the concentration of cefazolin; Other: S. aureus culture isolate; Other: structured telephone interview; Other: Sub-study quantitative measurement of Torque Teno virus
Sub-study: cefazolin concentrations in sweatOut of the study population (patients with CSAI) a total of 15 CSAI patients will be included for the substudy investigating cefazolin concentrations in sweat as a non-invasive therapeutic drug monitoring.
Receives: Other: Blood samples for the measurement of the concentration of cefazolin; Other: S. aureus culture isolate; Other: structured telephone interview; Other: Sub-study investigating cefazolin concentrations in sweat

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Trough concentration of cefazolin in plasma samples

    Trough concentration of cefazolin measured in plasma samples

    Measured: 1st (mid-dose and trough sample), 3rd (mid-dose and trough sample),7th and 14th day (for both only trough sample) of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  2. Total plasma concentrations of cefazolin in plasma samples

    Total plasma concentrations of cefazolin in plasma samples

    Measured: 1st (mid-dose and trough sample), 3rd (mid-dose and trough sample) of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  3. Free drug concentrations of cefazolin in plasma samples

    Free drug concentrations of cefazolin in plasma samples

    Measured: 1st (mid-dose and trough sample), 3rd (mid-dose and trough sample) of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  4. Trough concentration of cefazolin in sweat samples

    Trough concentration of cefazolin measured in sweat samples

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  5. Total sweat concentrations of cefazolin

    Total sweat concentrations of cefazolin

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  6. Free drug concentrations of cefazolin in sweat samples

    Free drug concentrations of cefazolin in sweat samples

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  7. Target attainment (100%fT>MIC)

    Antibiotic susceptibility of the isolated pathogens determined by the use of an Minimum inhibitory concentration (MIC) test strip. Target attainment (100%fT>MIC) will be calculated for each patient and for each day the patient was sampled. Target attainment is defined as a measured free trough plasma concentration of cefazolin above the measured exact MICs of the causative pathogens at all points of time sampled.

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

Secondary outcomes (5)
  1. Pharmacological target attainment (100%fT>MIC) in infected tissue

    For the analysis of pharmacological target attainment (100%fT>MIC) in infected tissue (only patients with a suggestive focus or metastatic complication of BSI will be included for this analysis) free trough concentration of cefazolin will be measured in plasma samples.

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  2. Attainment of an accepted threshold for toxicity (100%fT>10xMIC) in blood

    For the analysis of attainment of an accepted threshold for toxicity (100%fT>10xMIC) in blood, trough free concentration of cefazolin will be measured in plasma samples. Attainment of the threshold for toxicity is defined as measured free trough plasma concentration of cefazolin above at least 10x the measured exact MIC or above the clinical breakpoint MIC of the causative pathogen as published by the European Committee on Antimicrobial Susceptibility Testing at one time point or more. Cefazolin concentrations in sweat will be compared between patients with attained toxicity and non-attained thresholds in plasma.

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  3. Level of cefazolin tolerance of the isolated pathogen

    The level of cefazolin tolerance of the isolated pathogen will be determined by the tolerance disc test as well as through time-kill curves. The level of tolerance determines the required antibiotic concentration to achieve bactericidal killing.

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  4. TTV substudy: quantification of DNA

    For the TTV substudy DNA will be extracted from ethylenediaminetetraacetic acid (EDTA) blood and quantified

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

  5. TTV substudy: quantification of cytokines

    Cytokines as a markers of the activation status of the immune system will be quantified by using commercially available ELISA kits.

    Measured: 1st, 3rd,7th and 14th day of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Aug 2020
  2. Study start14 Jan 2020
  3. Primary completion28 Mar 2022
  4. Study completion28 Mar 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04503252
Sponsor's protocol ID
2019-02229; me20Osthoff2
Other IDs
2019
Acronym
TARGET II
Status last verified
Mar 2022
First submitted
29 Jul 2020
Last updated
29 Mar 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

An observational study of Staphylococcus Aureus Infection, run by University Hospital, Basel, Switzerland at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Mar 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Trough concentration of cefazolin in plasma samples (time frame: 1st (mid-dose and trough sample), 3rd (mid-dose and trough sample),7th and 14th day (for both only trough sample) of cefazolin treatment (+/-1-5 day) and if applicable in weekly intervals during outpatient parenteral antibiotic treatment (within 4 weeks)). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Mar 2022.

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