AzTrials
AzTrials

Staphylococcus Aureus BacteremiaPhase 4SNAPNCT05137119

Staphylococcus Aureus Network Adaptive Platform Trial

A Phase 4 study testing Cefazolin, Penicillin and Clindamycin in people with Staphylococcus Aureus Bacteremia, run by University of Melbourne at 161 sites in 13 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is an International Multi-Centered Randomised Adaptive Platform Clinical Trial to evaluate a range of interventions to reduce mortality for patients with Staphylococcus Aureus bacteraemia (SAB). Read more about this study

Who is it for?
Any age
Conditions the study is for
Staphylococcus Aureus Bacteremia
What is being tested?
Cefazolin, Penicillin and Clindamycin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
8,000 participants
Where
161 sitesin 13 countries
Study dates
16 Feb 2022to 1 Dec 2028
Phase
Phase 4
Are there results?
Not yet: the study is under way

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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • All participants that met the PLATFORM eligible are eligible to be included in this domain unless they meet any of the following exclusions listed.
  • Patients are eligible for this domain regardless of S. aureus susceptibility testing results to clindamycin.
  • For PSSA silo: Index blood culture isolate is penicillin-susceptible as per the Microbiology Appendix. In short, this will require phenotypic disc testing with EUCAST (a P1 disc diffusion with zone >=26mm OR a P1 disc diffusion with zone >=26mm and the zone edge is NOT sharp) OR CLSI (a P10 disc diffusion) defined criteria.
  • For MSSA silo: Index blood culture isolate is methicillin-susceptible as per the Microbiology Appendix.
  • Note that where trial sites are not testing for penicillin-susceptibility, patients with MSSA/PRSA can be included in the MSSA silo, but those with MSSA/PSSA (but not confirmed with a P-disc) will be excluded from the backbone domain. The rationale for this is that patients with MSSA but not tested with a P-disc may be truly PSSA (with no blaZ). If the cefazolin inoculum effect (CIE) is a clinically relevant entity, then including patients with an organism without blaZ (and hence cannot have a CIE phenotype), will bias towards non-inferiority of cefazolin compared to (flu)cloxacillin.
  • For PSSA, the requirement for laboratories to use an accredited phenotypic test for a penicillin-susceptible phenotype, is to ensure clinical safety according to internationally accepted guidelines. The automated antimicrobial susceptibility testing, and other phenotypic tests, have poor sensitivity for detection of blaZ compared to a gold standard of blaZ PCR. Therefore, patients could be placed at risk of treatment with benzylpenicillin when the infecting isolate is actually blaZ positive, unless these guidelines are followed.
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  • 1. MRSA confirmed microbiologically
  • Day 7 (+/- 2 days):
  • Clearance of SAB by platform Day 2: blood cultures negative for S. aureus from platform Day 2 onwards AND no known subsequent positive blood cultures
  • Afebrile (<37.8°C) for the past 72 hours (at time of judging eligibility)
  • Primary focus is either line related (either central or peripheral IV cannula) or skin and soft tissue, AND source control achieved (for 'line-related' this means line removed; for 'skin and soft tissue' means site PI considers source control to have been achieved and any abscess more than 2cm diameter has been drained)
  • No evidence of metastatic foci (on clinical or radiological examination, but radiological imaging is not required to exclude metastatic foci if not clinically indicated)
  • Day 14 (+/- 2 days):
  • Clearance of SAB by platform Day 5: blood cultures negative for S. aureus from platform Day 5 (+/-1 day) AND no known subsequent positive blood cultures. If the most recent blood culture from Day 2-4 is negative for S. aureus, blood cultures do not need to be repeated on Day 5 to fulfil eligibility criteria (Day 5 blood cultures will be assumed to be negative in this situation)
  • Afebrile (<37.8°C) for the past 72 hours (at time of judging eligibility)
  • Site Principal Investigator has determined that source control is adequate
  • PET/CT participating site
  • Patient is accessible for PET/CT - a patient is considered accessible if the site team are able to access the participant medical records, arrange for a PET/CT scan for the patient, and discuss this domain with the patient and their treating healthcare providers.

Who cannot join

  • 1. Previous type 1 hypersensitivity reaction to lincosamides 2. Currently receiving clindamycin (lincomycin) or linezolid which cannot be ceased or substituted 3. Necrotising fasciitis 4. Current C. difficile associated diarrhoea (any severity) 5. Current severe diarrhoea from any cause (defined as Grade 3 or higher) 5. Known CDAD (C.Difficile Associated Diarrhoea) in the past 3 months, or CDAD relapse in the past 12 months 6. At the time of domain eligibility assessment, more than 4 hours has elapsed since platform entry 7. Treating clinician deems enrolment in this domain is not in the best interest of the patient
  • PSSA, MSSA TREATMENT DOMAIN (backbone)
  • >72 hours have elapsed since the collection of the index blood culture (i.e. the time of collection of the first positive blood culture from the patient during this episode)
  • History of type I hypersensitivity reaction (i.e. anaphylaxis or angioedema) to any penicillin or cephalosporin
  • History of severe delayed reaction (e.g. allergic interstitial nephritis, cutaneous vasculitis, Stevens-Johnson, DRESS, etc.) to any penicillin or cephalosporin
  • PSSA silo: Non-severe rash to any penicillin (unless patient has been subsequently de-labelled; this criteria does not include criteria 2 and 3 above), or MSSA silo: Non-severe rash to cefazolin or any penicillin (unless patient has been subsequently de-labelled); (Nausea, diarrhoea, headache, and other non-specific symptoms are NOT allergies, they are drug intolerance, and they are not exclusion criteria. Similarly, a vague history of an allergy of unclear nature, or a family history of allergy are not exclusions.)
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  • Treating team deems enrolment in this domain is not in the best interest of the patient
  • Currently receiving maintenance dialysis (haemodialysis or peritoneal dialysis); (Acute renal replacement therapy (including CRRT, haemodialysis or peritoneal dialysis) are not exclusions. Such patients are eligible as long as appropriate vascular access is available or can be arranged.)
  • Polymicrobial bacteraemia (defined as more than one organism [at species level] in blood cultures, excluding those organisms judged to be contaminants by either the microbiology laboratory or treating clinician) reported between collection of the index blood culture and backbone domain eligibility assessment
  • Patient currently being treated with a systemic antibacterial agent that cannot be ceased or substituted for interventions allocated within the platform (unless antibiotic is listed in Table 1 of the DSA, which specifies allowed antibiotics with limited absorption from the gastrointestinal tract or negligible antimicrobial activity against S. aureus)
  • MRSA TREATMENT DOMAIN (backbone)
  • Time to allocation reveal is >72 hours from time of index blood culture collection
  • Severe allergy to any beta-lactam (including cefazolin) Immediate severe allergy: Anaphylaxis/angioedema Severe delayed allergy: Severe cutaneous adverse reaction (SCAR; including Steven Johnson Syndrome, Toxic Epidermal Necrolysis, Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) and acute generalised exanthematous pustulosis (AGEP)), severe drug induced liver injury, proven allergic interstitial nephritis, immune-mediated haemolytic anaemia and other severe cytopenia.
  • Non-severe rash to cefazolin Nausea, diarrhoea, headache and other non-specific symptoms are NOT allergies, they are drug intolerance, and they are not exclusion criteria. Similarly, a vague history of an allergy of unclear nature, or a family history of allergy are not exclusions.)
  • 3. Severe allergy or non-severe rash to both vancomycin AND daptomycin Vancomycin infusion reaction (formerly known as "red man syndrome") is due to direct histamine release and is not generally an allergy, and therefore is not considered an exclusion.
  • 5. Treating team deems enrolment in the domain is not in the best interest of the patient 6. Polymicrobial bacteraemia (defined as more than one organism [at species level] in blood cultures, excluding those organisms judged to be contaminants by either the microbiology laboratory or treating clinician) reported between collection of the index blood culture and backbone domain eligibility assessment.
  • 7. Patient currently being treated with a systemic antibacterial agent that cannot be ceased or substituted for interventions allocated within the platform (unless antibiotic is listed in Table 1 of the DSA, which specifies allowed antibiotics with limited absorption from the gastrointestinal tract or negligible antimicrobial activity against S. aureus)
  • EARLY ORAL SWITCH DOMAIN
  • When judging eligibility at platform Day 7 (+/- 2 days) and at Day 14 (+/- 2 days), exclusion criteria are:
  • Adherence to oral agents unlikely (as judged by site PI in consultation with the treating team)
  • Unreliable gastrointestinal absorption (e.g. vomiting, diarrhoea, nil by mouth, anatomical reasons)
  • There are no appropriate oral antibiotics due to contraindications, drug availability, or antibiotic resistance
  • Ongoing IV therapy unsuitable e.g. no IV access
  • Clinician deems not appropriate for early oral switch
  • Patient no longer willing to participate in domain In the lead-up to judging eligibility, it may be helpful to discuss with the patient the potential for continued IV treatment versus oral switch, to allow hospital discharge planning
  • Clinical team deems that sufficient duration of antibiotic therapy has already been provided
  • Exclusions when judging eligibility for early oral switch at trial Day 7 (+/- 2 days):
  • Presence of prosthetic cardiac valve, pacemaker or other intracardiac implant
  • Presence of intravascular clot, graft, or other intravascular prosthetic material Intravascular clot excludes superficial peripheral IV line-related thrombophlebitis. Intravascular prosthetic material excludes coronary artery stents)
  • Intravascular/intracardiac infections (e.g. endocarditis, mycotic aneurysm)
  • Presence of other intracardiac abnormalities felt to put patient at increased risk of endocarditis (e.g., bicuspid aortic valve)
  • PET/CT DOMAIN
  • Pregnant - patients of childbearing potential should be assessed for pregnancy status and a pregnancy test performed (if not performed within the past 10 days)
  • Currently breastfeeding
  • < 18 years of age
  • Patient has had PET/CT in the past 7 days
  • Patient needs PET/CT in the next 7 days (in the opinion of the clinical team, at the time of eligibility assessment)
  • Clinically unstable for PET/CT (as judged by the treating clinical team, taking into account need for organ support (including inotropes) and capacity to lie flat for the PET/CT)
  • Contraindication to PET/CT (e.g., claustrophobia, persistently elevated blood sugar levels [>12.5mmol/L] that cannot be corrected).
  • Patient no longer willing to participate in the domain - in the days leading up to judging eligibility, it may be helpful to discuss with the patient the potential for PET/CT vs no PET/CT to allow imaging planning
  • Clinician deems participation in this domain is not in the patient's best interests

Trial locations and contacts

161 sites in 13 countries. Contact the study team or a site near you to ask about taking part.

Lauren Barina contact

+61 (03) 8344 1623

lauren.barina@unimelb.edu.au

Susan Goulding contact

+61 (03) 8344 7799

susan.goulding@unimelb.edu.au

161 sites in 13 countries

Australia51 sites, 50 recruiting

  • Lyell McEwin Hospital

    Adelaide, South Australia, 5112

    Rory Hannah

    Recruiting

  • Grampians Health

    Ballarat, Victoria, 3350

    Robert Commons

    Recruiting

  • Flinders Medical Centre

    Bedford Park, South Australia, 5042

    Nicholas Anagnostou

    Recruiting

  • Bendigo Health

    Bendigo, Victoria, 3550

    Andrew Mahony

    Recruiting

  • Sunshine Coast University Hospital

    Birtinya, Queensland, 4575

    David Sowden

    Shradha Subedi

    Recruiting

  • Blacktown Hospital

    Blacktown, New South Wales, 2148

    Ravindra Dotel

    Recruiting

  • Box Hill Hospital

    Box Hill, Victoria, 3128

    Stephen Guy

    Recruiting

  • Cairns Hospital

    Cairns, Queensland, 4870

    Simon Smith

    Recruiting

  • Royal Prince Alfred Hospital

    Camperdown, New South Wales, 2050

    Sebastian VanHal

    Recruiting

  • Monash Children's Hospital

    Clayton, Victoria, 3168

    Jeremy Carr

    Not yet recruiting

  • Monash Health - Monash Medical Centre & Jesse McPherson Private Hospital

    Clayton, Victoria, 3168

    Ben Rogers

    Recruiting

  • Concord Repatriation and General Hospital

    Concord, New South Wales, 2139

    Genevieve McKew

    Timothy Gray

    Recruiting

  • St Vincent's Hospital Sydney

    Darlinghurst, New South Wales, 2010

    Gail Matthews

    Recruiting

  • Western Health - Footscray, Joan Kirner & Sunshine Hospitals

    Footscray, Victoria, 3011

    Adrian Tramontana

    Recruiting

  • Frankston Hospital

    Frankston, Victoria, 3199

    Kasha Singh

    Not yet recruiting

  • Canberra Hospital

    Garran, Australia Capital Territory, 2605

    Heather Wilson

    Recruiting

  • Barwon Health - University Hospital Geelong

    Geelong, Victoria, 3220

    Eugene Athan

    Recruiting

  • Austin Hospital

    Heidelberg, Victoria, 3084

    Natasha Holmes

    Recruiting

  • Royal Brisbane and Women's Hospital

    Herston, Queensland, 4029

    Bridget Barber

    Recruiting

  • Royal Hobart Hospital

    Hobart, Tasmania, 7000

    Peter Leung

    Not yet recruiting

  • Ipswich Hospital

    Ipswich, Queensland, 4305

    John Woodford

    Recruiting

  • Nepean Hospital

    Kingswood, New South Wales, 2747

    Archana Sud

    Recruiting

  • St George Hospital

    Kogarah, New South Wales, 2217

    Katy Lai

    Not yet recruiting

  • Launceston Hospital

    Launceston, Tasmania, 7250

    Ali Trad

    Recruiting

  • Liverpool Hospital

    Liverpool, New South Wales, 2170

    Hong Foo

    Recruiting

  • Logan Hospital

    Meadowbrook, Queensland, 4131

    Vichitra Sukumaran

    Not yet recruiting

  • Alfred Hospital

    Melbourne, Victoria, 3004

    James McMahon

    James McMahon

    Recruiting

  • Fiona Stanley Hospital

    Murdoch, Western Australia, 6150

    Owen Robinson

    Recruiting

  • Perth Children's Hospital

    Nedlands, Western Australia, 6009

    Asha Bowen

    Anita Campbell

    Recruiting

  • John Hunter Hospital

    New Lambton Heights, New South Wales, 2305

    Brian Chong

    Recruiting

  • John Hunter Children's Hospital

    Newcastle, New South Wales, 2305

    Coen Butters

    Recruiting

  • Women and Children's Hospital

    North Adelaide, South Australia, 5006

    Michael Stark

    Not yet recruiting

  • Women's and Children's Hospital

    North Adelaide, South Australia, 5006

    Nan Vasilunas

    Not yet recruiting

  • Orange Health Service

    Orange, New South Wales, 2800

    Jacob Williams

    Recruiting

  • Royal Melbourne Hospital

    Parkville, Victoria, 3050

    Justin Denholm

    Recruiting

  • Royal Children's Hospital Melbourne

    Parkville, Victoria, 3052

    Amanda Gwee

    Recruiting

  • Royal Perth Hospital

    Perth, Western Australia, 6000

    Owen Robinson

    Recruiting

  • Armadale Hospital

    Perth, Western Australia, 6112

    David New

    Recruiting

  • Prince of Wales Hospital

    Randwick, New South Wales, 2031

    Trine Gulholm

    Recruiting

  • Sydney Children's Hospital

    Randwick, New South Wales, 2031

    Brendan McMullan

    Recruiting

  • Redcliffe Hospital

    Redcliffe, Queensland, 4020

    Kevin O'Callaghan

    Recruiting

  • Robina Hospital

    Robina, Queensland, 4226

    Peter Simos

    Recruiting

  • Goulburn Valley Health

    Shepparton, Victoria, 3630

    Completed

  • Queensland Children's Hospital

    South Brisbane, Queensland, 4101

    Clare Nourse

    Recruiting

  • Gold Coast University Hospital

    Southport, Queensland, 4215

    Peter Simos

    Recruiting

  • Royal Darwin Hospital

    Tiwi, Northern Territory, 0811

    Jane Davies

    Josh Francis

    Recruiting

  • La Trobe Regional Hospital

    Traralgon, Victoria, 3844

    Zaal Meher-Homji

    Not yet recruiting

  • The Children's Hospital at Westmead

    Westmead, New South Wales, 2145

    Philip Britton

    Recruiting

  • Westmead Hospital

    Westmead, New South Wales, 2145

    Matthew O'Sullivan

    Recruiting

  • Wollongong Hospital

    Wollongong, New South Wales, 2500

    Niladri Ghosh

    Recruiting

  • Princess Alexandra Hospital

    Woolloongabba, Queensland, 4102

    Andrew Henderson

    Not yet recruiting

Other trials in Australia

Canada37 sites, 33 recruiting

  • Peter Lougheed Centre

    Calgary, Alberta, T1Y 6J4

    Ranjani Somayaji

    Recruiting

  • Foothills Medical Center

    Calgary, Alberta, T2N4Z6

    Ranjani Somayaji

    Recruiting

  • Rockyview Hospital

    Calgary, Alberta, T2V 1P9

    Ranjani Somayaji

    Recruiting

  • South Health Campus

    Calgary, Alberta, T3M 1M4

    Ranjani Somayaji

    Recruiting

  • Toronto East Health Network - Michael Garron Hospital

    East York, Ontario, M4C3E7

    Christopher Kandel

    Recruiting

  • University Health Network - Toronto General Hospital

    East York, Ontario, M5G2C4

    Completed

  • University of Alberta Hospital

    Edmonton, Alberta, T6G2B7

    Stephanie Smith

    Recruiting

  • Hamilton Health Sciences - Hamilton General Hospital

    Hamilton, Ontario, L8P1A2

    Dominik Mertz

    Recruiting

  • Hamilton Health Sciences - Juravinski Hospital

    Hamilton, Ontario

    Dominik Mertz

    Recruiting

  • Kingston Health Sciences Centre - Kingston General Hospital

    Kingston, Ontario, K7L2V7

    Anthony Bai

    Recruiting

  • CISSS - Hôpital Cité-de-la-Santé Hospital

    Laval, Quebec

    Stephanie Castonguay

    Recruiting

  • London Health Sciences Centre - University Hospital, LHSC

    London, Ontario

    Completed

  • Jewish General Hospital

    Montreal, Quebec, H3T1E2

    Leighanne Parkes

    Recruiting

  • McGill University Health Centre - Montral General Hospital

    Montreal, Quebec, H4A3J1

    Matthew Cheng

    Recruiting

  • McGill University Health Centre - Montreal Children's Hospital

    Montreal, Quebec

    Jesse Pappenburg

    Not yet recruiting

  • McGill University Health Centre - Royal Victoria Hospital

    Montreal, Quebec

    Matthew Cheng

    Recruiting

  • Niagara Health - Niagara Falls Site

    Niagara Falls, Ontario

    David McCullagh

    Recruiting

  • The Ottawa Hospital - Civic Campus

    Ottawa, Ontario, K1H8L6

    Derek MacFadden

    Recruiting

  • The Ottawa Hospital - General Campus

    Ottawa, Ontario

    Derek MacFadden

    Recruiting

  • Richmond Hospital

    Richmond, British Columbia, V6X1A2

    Clement Kwok

    Recruiting

  • Hôpital Régional de Saint Jérôme

    Saint-Jérôme, Quebec, J7Z5T3

    Sébastien Poulin

    Recruiting

  • Sault Area Hospital

    Sault Ste. Marie, Ontario, P6B 0A8

    Completed

  • University of Sherbrooke Health Centre - Hospital Fleurimont

    Sherbrooke, Quebec, J1H 5H3

    Francois Lamontagne

    Recruiting

  • University of Sherbrooke Health Centre - Hotel Dieu

    Sherbrooke, Quebec

    Francois Lamontagne

    Recruiting

  • Niagara Health - St. Catharines Site

    St. Catharines, Ontario, L2S 0A9

    David McCullagh

    Recruiting

  • Eastern Health - Health Sciences Centre (Memorial University)

    St. John's, Newfoundland and Labrador, A1B3V6

    Peter Daley

    Recruiting

  • Eastern Regional Health Authority - St. Clare's Mercy Hospital

    St. John's, Newfoundland and Labrador

    Peter Daley

    Recruiting

  • Fraser Health Authority - Surrey Memorial Hospital

    Surrey, British Columbia

    Kevin Afra

    Recruiting

  • Unity Health - St Michael's Hospital

    Toronto, Ontario, M1L 1W1

    Matthew Muller

    Recruiting

  • Sunnybrook Health Sciences Centre

    Toronto, Ontario, M4N3M5

    Nick Daneman

    Recruiting

  • Sinai Heath System - Mount Sinai Hospital

    Toronto, Ontario, M5G1X5

    Jennie Johnstone

    Recruiting

  • Unity Health Toronto - St Joseph's Health Centre

    Toronto, Ontario

    Kevin Schwarz

    Recruiting

  • University Health Network - Toronto Western Hospital

    Toronto, Ontario

    Completed

  • Vancouver General Hospital

    Vancouver, British Columbia, V5Z1M9

    Jennifer Grant

    Recruiting

  • St. Boniface Hospital

    Winnipeg, Manitoba, R2H 2A6

    Terry Wuerz

    Recruiting

  • Health Sciences Centre Winnipeg

    Winnipeg, Manitoba, R3A1R9

    Terry Wuerz

    Recruiting

  • Grace Hospital

    Winnipeg, Manitoba, R3J 3M7

    Terry Wuerz

    Recruiting

Other trials in Canada

United Kingdom34 sites, 34 recruiting

  • NHS Grampian

    Aberdeen

    Robin Brittain-Long

    Not yet recruiting

  • University Hospitals Birmingham

    Birmingham

    James Scriven

    Recruiting

  • Brighton and Sussex University Hospitals

    Brighton

    Sunil Sharma

    Recruiting

  • North Bristol

    Bristol

    Ed Moran

    Recruiting

  • University Hospitals Bristol and Weston

    Bristol

    Raje Dhillon

    Recruiting

  • Cambridge University Hospitals

    Cambridge

    Theodore Gouliouris

    Not yet recruiting

  • Cardiff and Vale University

    Cardiff

    Jonathan Underwood

    Recruiting

  • Royal Cornwall Hospitals

    Cornwall

    Ollie Lloyd

    Not yet recruiting

  • Royal Devon University Healthcare

    Devon

    Rachel Patel

    Not yet recruiting

  • NHS Tayside

    Dundee

    Nikolas Rae

    Not yet recruiting

  • Lothian Western General

    Edinburgh

    Rebecca Sutherland

    Recruiting

  • Greater Glasgow and Clyde

    Glasgow

    Michael Murphey

    Not yet recruiting

  • NHS Golden Jubilee

    Glasgow

    Fiona Thornburn

    Not yet recruiting

  • Hull University Teaching Hospitals

    Hull

    Nick Easom

    Recruiting

  • Leeds Teaching Hospitals

    Leeds

    Fiona McGill

    Recruiting

  • Liverpool University Hospital

    Liverpool

    Steve Aston

    Recruiting

  • Barts Health

    London

    Mildred Iro

    Recruiting

  • Great Ormond Street

    London

    James Hatcher

    Not yet recruiting

  • Guys and St Thomas'

    London

    Anna Goodman

    Recruiting

  • Imperial College Healthcare

    London

    Claire Waddlington

    Recruiting

  • Kings College Hospital

    London

    Jasmin Isalm

    Not yet recruiting

  • Royal Free London

    London

    Indran Balakrishnan

    Recruiting

  • University College London Hospitals

    London

    Michael Marks

    Recruiting

  • Whittington Health

    London

    Ana Garcia Mingo

    Recruiting

  • Manchester University Hospitals

    Manchester

    Mike Riste

    Recruiting

  • Newcastle Upon Tyne Hospitals

    Newcastle upon Tyne

    Ashley (David) Price

    Recruiting

  • Nottingham University Hospitals

    Nottingham

    Tim Sloan

    Not yet recruiting

  • Oxford University Hospitals

    Oxford

    Matthew Scarborough

    Recruiting

  • Sheffield Teaching Hospitals

    Sheffield

    Julia Grieg

    Not yet recruiting

  • South Tees Hospitals

    South Tees

    John Widdrington

    Recruiting

  • University Hospital Southampton

    Southampton

    Kordo Saeed

    Recruiting

  • NHS Forth Valley

    Stirling

    Elan Tsarfati

    Not yet recruiting

  • University Hospitals of North Midlands

    Stoke

    Krishna Banavathi

    Not yet recruiting

  • Swansea Bay University Health Board

    Swansea

    Brendan Healy

    Recruiting

Other trials in United Kingdom

New Zealand11 sites, 11 recruiting

  • Starship Hospital

    Auckland, 1023

    Rachel Webb

    Recruiting

  • KidzFirst

    Auckland, 2025

    Rachel Webb

    Recruiting

  • Hutt Valley Hospital

    Boulcott, Lower Hutt, 5010

    Matthew Kelly

    Recruiting

  • Christchurch Hospital

    Christchurch, Canterbury, 8011

    Sarah Metcalf

    Not yet recruiting

  • Auckland City Hospital

    Grafton, Auckland, 1023

    Mark Hobbs

    Recruiting

  • Waikato Hospital

    Hamilton, 3240

    Paul Huggan

    Recruiting

  • Wellington Hospital

    Newtown, Wellington Region, 6021

    Max Bloomfield

    Recruiting

  • Middlemore Hospital

    Otahuhu, Auckland, 1640

    Genevieve Walls

    Rachel Webb

    Recruiting

  • North Shore Hospital

    Takapuna, Auckland, 0620

    Nick Gow

    Recruiting

  • Tauranga Hospital

    Tauranga, 3112

    Kate Grimwade

    Recruiting

  • Whangarei Hospital

    Whangarei, 0148

    David Hammer

    Not yet recruiting

Other trials in New Zealand

Netherlands9 sites, 7 recruiting

  • Jeroen Bosch Hospital

    's-Hertogenbosch

    Thijs ten Doesschate

    Recruiting

  • Rijnstate Hospital

    Arnhem

    Active, not recruiting

  • Treant Ziekenhuis

    Emmen

    Sander van Assen

    Recruiting

  • UMC Groningen

    Groningen

    Active, not recruiting

  • Maastricht UMC+

    Maastricht

    Astrid Oude Lashof

    Recruiting

  • Antonius Ziekenhuis

    Nieuwegein

    Bas Weijer

    Recruiting

  • Radboud University Medical Center

    Nijmegen

    Nynke Jager

    Recruiting

  • Ikazia Ziekenhuis

    Rotterdam

    Felix de Jongh

    Recruiting

  • University Medical Center Utrecht

    Utrecht

    Marjolein Hensgens

    Recruiting

Other trials in Netherlands

Germany4 sites, 4 recruiting

  • Charité University Hospital Berlin

    Berlin

    Miriam Stegemann

    Recruiting

  • University Hospital Carl Gustav Carus Dresden

    Dresden

    Katja de With

    Recruiting

  • University Medical Centre Freiburg

    Freiburg im Breisgau

    Siegbert Richard Rieg

    Recruiting

  • Otto-von-Guericke-university Magdeburg

    Magdeburg

    Achim Kaasch

    Recruiting

Other trials in Germany

Israel4 sites, 4 recruiting

  • Rambam Health Care Campus

    Haifa, 310960

    Mical Paul

    Recruiting

  • Beilinson Hospital

    Petah Tikva, 49100

    Noa Eliakim-Raz

    Recruiting

  • Schneider Hospital

    Petah Tikva

    Oded Scheureman

    Recruiting

  • Sheba Medical Centre

    Ramat Gan, 49100

    Dafna Yahav

    Recruiting

Other trials in Israel

Singapore3 sites, 3 recruiting

  • National University Hospital

    Singapore, 119228

    Sophia Archuleta

    Recruiting

  • Singapore General Hospital

    Singapore, 168753

    Shirin Kalimuddin

    Recruiting

  • Tan Tock Seng Hospital

    Singapore, 308433

    David Lye

    Recruiting

Other trials in Singapore

South Africa3 sites, 2 recruiting

  • Charlotte Maxeke Johannesburg Academic Hospital

    Johannesburg

    Not yet recruiting

  • Helen Joseph Hospital

    Johannesburg

    Active, not recruiting

  • Rahima Moosa Mother and Child Hospital

    Johannesburg

    Not yet recruiting

Other trials in South Africa

Sweden2 sites, 2 recruiting

  • Helsingborg Hospital

    Helsingborg

    Jonas Tverring

    Recruiting

  • SUS Malmö

    Malmö

    Maria Josephson

    Recruiting

Other trials in Sweden

United States1 site, 1 recruiting

  • Houston Methodist Research Institute

    Houston, Texas, 77030

    Cesar Arias, 346-651-8674, caarias@houstonmethodist.org

    Recruiting

Other trials in United States

France1 site, 1 recruiting

  • CHU de Rennes - Hôpital Pontchaillou

    Rennes

    David Luque Paz

    Recruiting

Other trials in France

Japan1 site, 1 recruiting

  • Science Tokyo University Hospital

    Ichikawa, Chiba, 272-0827

    Principal Investigator Yoshiaki Gu

    Recruiting

Other trials in Japan

About this study

The Staphylococcus aureus Network Adaptive Platform (SNAP) trial is an International Multi-Centered Randomised Adaptive Platform Clinical Trial to evaluate a range of interventions to reduce mortality for patients with Staphylococcus Aureus bacteraemia (SAB).

Read the detailed description

Infection of the bloodstream with the bacterium Staphylococcus aureus (Staphylococcus aureus bacteraemia, SAB) is a serious infection that results in 15-30% of affected patients dying within three months of acquiring the infection. Treatment of this infection requires patients to be hospitalised, treated with prolonged antibiotics through an intravenous line, and carefully examined for the occurrence of complications associated with this condition. At present, there are many treatment options in current use, with no clear agreement as to which of these is best. The SNAP trial aims to identify which treatment options for SAB results in the fewest patients dying within the first 90 days after an infection.

In contrast to a conventional clinical trial, the SNAP trial will examine multiple different treatment options at once. Patients will be randomly assigned to different concurrent treatment options currently considered acceptable in routine medical care, but as the trial progresses, more patients will be assigned to treatments that appear to have better outcomes than those with worse outcomes. The trial will adapt to accumulating trial evidence, on a regular basis, by removing treatment options found to be inferior, incorporating new treatment options, and ensuring that all patients in the trial receive the best treatments once they have been identified. Over time, we hope to determine the best combination of treatment options for patients with SAB.

The SNAP Trial infrastructure will also support a number of sub-studies. A list of all active sub-studies can be found on the SNAP website: https://www.snaptrial.com.au/substudies.

Being tested
Cefazolin, Penicillin, Clindamycin, Vancomycin, Effectiveness of early switch to oral antibiotics
Keywords
Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-susceptible Staphylococcus aureus (MSSA), Penicillin-susceptible Staphylococcus aureus (PSSA), Staphylococcus aureus, S. aureus, Staph Aureus Bacteremia (SAB)
Medical subject headings
Staphylococcal Infections

What participants receive

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

  • CefazolinDrug

    Cefazolin

  • PenicillinDrug

    Also called Benzylpenicillin, Penicillin G

    benzylpenicillin

  • ClindamycinDrug

    Also called Lincomycin

    Clindamycin

  • VancomycinDrug

    Also called Daptomycin

    Vancomycin or Daptomycin

  • Effectiveness of early switch to oral antibioticsOther

    This involves testing a strategy rather than individual antibiotic agents

  • Whole body FDG PET/CT ImagingRadiation

    Whole body FDG PET/CT imaging will be performed using a standardised protocol describing patient preparation and minimum specifications for radiopharmaceutical production, quality control, and PET/CT acquisition.

Study groups in NCT05137119
Study groupRoleWhat they receive
Methicillin-resistant staphylococcus aureus (MRSA) - Standard Therapy Arm (backbone therapy)No interventionVancomycin or Daptomycin - Standard Therapy Arm Either intravenous vancomycin dosed as per Australian Therapeutic Guidelines: This includes a loading dose of 25 mg/kg (up to 3000mg) if considered appropriate by the treating clinician, initial maintenance dosing at 15-20 mg/kg q12h, with subsequent adjustment to maintain area under the concentration-time curve (AUC) of 400 to 600 mg.hr/L OR trough levels at 10-20 mg/L, and the initial level taken 48-72 hours after the initiation of the first dose. Daptomycin 8-10mg/kg per day intravenously. The choice of vancomycin or daptomycin will be at the clinician's discretion. Dosing will be based on renal function.
Methicillin-resistant staphylococcus aureus (MRSA) - Standard + B-Lactam Arm (backbone therapy)ExperimentalVancomycin or Daptomycin (Standard Therapy) + Beta-Lactam (β-lactam) Arm In addition to standard treatment an intravenous β-lactam will be added for the first 7 calendar days following randomisation (day 1 being the day of randomisation - hence patients will receive 6-7 days of β-lactam). This β-lactam will be intravenous cefazolin 2g every 8 hours. For patients with renal impairment the intravenous cefazolin administration doses will be adjusted.
Receives: Drug: Cefazolin; Drug: Vancomycin
Methicillin-susceptible staphylococcus aureus (MSSA) - Standard Therapy Arm (backbone therapy)No interventionFlucloxacillin or cloxacillin - Standard Therapy Arm Either intravenous flucloxacillin/cloxacillin 2g every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous flucloxacillin administration dose will be adjusted.
Methicillin-susceptible staphylococcus aureus (MSSA) - Interventional Arm (backbone therapy)ExperimentalCefazolin - Interventional Arm Intravenous cefazolin 2g every 6 or 8 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous cefazolin administration dose will be adjusted.
Receives: Drug: Cefazolin
Penicillin-susceptible staphylococcus aureus (PSSA) - Standard Therapy Arm (backbone therapy)No interventionFlucloxacillin or cloxacillin - Standard Therapy Arm Either intravenous flucloxacillin/cloxacillin 2g every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with renal impairment or critical illness the intravenous flucloxacillin administration dose will be adjusted.
Penicillin-susceptible staphylococcus aureus (PSSA) - Interventional Arm (backbone therapy)ExperimentalBenzylpenicillin - Interventional Arm Intravenous benzylpenicillin 1.8g (3 million units) every 4 or 6 hours. The minimum protocol duration of allocated study treatment is 14 days for those not allocated to early oral switch, and 5 days for those allocated to early oral switch. For patients with critical illness the intravenous benzylpenicillin administration doses will be adjusted.
Receives: Drug: Penicillin
No adjunctive treatment in combination with MRSA or MSSA or PSSA backbone therapy armNo interventionNo adjunctive therapy + backbone therapy arm for MRSA or MSSA or PSSA Participants with either MRSA or MSSA or PSSA will have no adjunctive therapy in combination with their backbone therapy arm.
Adjunctive treatment in combination with MRSA or MSSA or PSSA backbone therapy armExperimentalAdjunctive therapy + backbone therapy arm for MRSA or MSSA or PSSA Intravenous clindamycin (or lincomycin) 600mg every 8 hours from platform day 1 to day 5. No dosage adjustment is needed to renal impairment.
Receives: Drug: Clindamycin
Continue intravenous antibiotic therapies (backbone +/- adjunctive therapy) - standard of care armNo interventionBackbone therapy arm for MRSA or MSSA or PSSA +/- adjunctive therapy will continue on intravenous antibiotic treatment for the length of time as per usual standard of care. Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised if not eligible then eligibility will be assess again at Day 14(+/- 2 days). If eligibility is not met at day 14 then participant is excluded from this domain.
Switch to oral antibiotics at trial day 7 (+/- 2 days) or Day 14 (+/- 2 days) if eligible.ExperimentalSwitch from intravenous backbone antibiotic for MRSA or MSSA or PSSA to oral antibiotics at the treating clinicians discretion on trial Day 7 (+/- 2 days) or trial Day 14 (+/- 2 days). Participants eligibility is assessed at Day 7 (+/- 2 days). If eligible will be randomised, if not eligible then eligibility will be assessed again at Day 14 (+/- 2 days). If eligibility is not met at day 14 then participant is excluded from this domain.
Receives: Other: Effectiveness of early switch to oral antibiotics
No PET/CT scan - standard of care armNo interventionParticipants will not receive a PET/CT scan, in addition to their allocated treatment interventions. Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised. If eligibility is not met then participant is excluded from this domain.
PET/CT scan at trial day 7 (+/- 2 days) if eligibleExperimentalParticipant will receive a PET/CT scan at Day 5-12, in addition to their allocated treatment interventions. Participants eligibility is assessed at Day 7 (+/- 2 days) if eligible will be randomised. If eligibility is not met then participant is excluded from this domain.
Receives: Radiation: Whole body FDG PET/CT Imaging

What is being measured

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

  1. All-cause mortality at 90 days after platform entry

    The primary endpoint for all cells and domains will be all-cause mortality at 90 days after platform entry.

    The primary endpoint will be determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.

    Measured: From randomisation (day 1) until day 90

Secondary outcomes (15)

  1. Core1: All-cause mortality at 14, 28 and 42 days after platform entry

    Determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.

    Measured: From randomisation (day 1) until day 14, 28, and 42

  2. Core2: Duration of survival censored at 90 days after platform entry

    Determined through a search of hospital databases for a record of a participant's death, or follow-up contact with the participant's community healthcare provider, or follow-up contact with the patient or their nominated carer, or linkage with death registries.

    Measured: From randomisation (day 1) until day 90

  3. Core3: Length of stay of acute index inpatient hospitalisation for those surviving until discharge from acute inpatient facilities (excluding HITH/COPAT/OPAT/rehab).

    Acute index hospitalisation is defined as continuous hospital admission to one or more acute inpatient facilities for the index episode. This does not include HITH/OPAT/COPAT and stepdown inpatient rehabilitation/post-acute care. It does include admission to acute care hospitals immediately preceding and following those at the enrolling site.

    Measured: From randomisation (day 1) until discharge from acute inpatient facilities, truncated at 90 days.

  4. Core4: Length of stay of total index hospitalisation for those surviving until hospital discharge (including HITH/COPAT/OPAT/rehab)

    Total index hospitalisation is defined as continuous hospital admission to one or more inpatient facilities for the index episode, including HITH/OPAT/COPAT and stepdown inpatient rehabilitation/post-acute care (if continuous with the initial inpatient admission).

    It includes admission to acute care hospitals immediately preceding and following those at the enrolling site.

    Measured: From randomisation (day 1) to discharge from total index hospitalisation, truncated at 90 days

  5. Core5: Time to being discharged alive from the total index hospitalisation (including HITH/COPAT/OPAT/rehab) truncated at 90 days after platform entry

    and all deaths within 90 days will be considered '90 days'

    Measured: From randomisation (day 1) to discharge from total index hospitalisation, truncated at 90 days

  6. Core6: Microbiological treatment failure defined as positive sterile site culture for S. aureus [of the same silo as the index isolate between 14 and 90 days after platform entry).

    A sterile site means any sites deep to the skin and skin structures, including deep visceral and musculoskeletal abscesses that have been obtained in a sterile manner.

    Measured: From day 14 until day 90

  7. Core7: Diagnosis of new foci between 14 and 90 days after platform entry.

    The presence of new foci will be determined by the site investigator and can incorporate clinical, radiological, microbiological and pathological findings.

    Measured: From day 14 until day 90

  8. Core8: C. difficile diarrhoea as determined by a clinical laboratory in the 90 days following platform entry for participants ≥2 years of age.

    This means a stool submitted to a clinical laboratory has tested positive for C. difficile toxin or toxin gene.

    Measured: From randomisation (day 1) until day 90

  9. Core9: Serious adverse reactions (SARs) in the 90 days following platform entry

    SARs defined only as serious events that are attributable to one or more randomised study interventions

    Measured: From randomisation (day 1) until day 90

  10. Core10: Health economic costs as detailed in the health ecnomics appendix.

    Including hospital length of stay, readmissions, and patient employment status.

    Measured: From randomisation (day 1) until day 90

  11. Core11: Proportion of participants who have returned to their usual level of function at day 90.

    Determined by whether the modified functional bloodstream infection score (FBIS) remained the same or improved between baseline and 90 days after platform entry where baseline=best score within the 4 weeks prior to platform entry.

    Measured: From randomisation (day 1) until day 90

  12. Core12: Desirability of outcome ranking 1 (DOOR1; modified Antibiotic Resistance Leadership Group version)

    See Core Protocol; unable to insert DOOR1 table

    Measured: From randomisation (day 1) until day 90

  13. Core13: Desirability of outcome ranking 2 (DOOR2; SNAP version)

    See Core Protocol; unable to insert DOOR2 table

    Measured: From randomisation (day 1) until day 90

  14. Core14: Total number of antibiotic days (IV and/or oral/enteral) in the 90 days following platform entry.

    All antibiotics should be included, not only those intended for treatment of S. aureus bacteraemia. It also includes prophylactic dose antibiotics (e.g., prophylactic dose trimethoprim-sulfamethoxazole).

    All days on which any antibiotic dose is received should be counted - i.e. we are counting the number of whole or part days on which any antibiotics are received (not the number of defined daily doses of antibiotics).

    Topical, inhaled or other routes of administration besides IV or oral/enteral should not be counted.

    Measured: From randomisation (day 1) until day 90

  15. Core15: Days alive and free of antibiotics in the 90 days following platform entry.

    All antibiotics should be included, not only those intended for treatment of S. aureus bacteraemia. It also includes prophylactic dose antibiotics (e.g., prophylactic dose trimethoprim-sulfamethoxazole).

    All days on which any antibiotic dose is received should be counted - i.e. we are counting the number of whole or part days on which any antibiotics are received (not the number of defined daily doses of antibiotics).

    Topical, inhaled or other routes of administration besides IV or oral/enteral should not be counted.

    Measured: From randomisation (day 1) until day 90

Timeline

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

  1. First posted30 Nov 2021
  2. Study start16 Feb 2022
  3. Primary completion1 Dec 2028 (estimated)
  4. Study completion1 Dec 2028 (estimated)

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Factorial
Model description
Participants enrolled into the study have the option of deciding whether to be randomised in one or more (if available) treatment domains concurrently, if they meet the eligibility criteria.
Masking
None (open label)
Enrolment
8,000 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05137119
Sponsor's protocol ID
CT19029
Acronym
SNAP
Status last verified
Jul 2025
First submitted
25 Apr 2021
Last updated
6 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified patient data

Publications

  • Tong SYC, Mora J, Bowen AC, Cheng MP, Daneman N, Goodman AL, Heriot GS, Lee TC, Lewis RJ, Lye DC, Mahar RK, Marsh J, McGlothlin A, McQuilten Z, Morpeth SC, Paterson DL, Price DJ, Roberts JA, Robinson JO, van Hal SJ, Walls G, Webb SA, Whiteway L, Yahav D, Davis JS; Staphylococcus aureus Network Adaptive Platform (SNAP) Study Group. The Staphylococcus aureus Network Adaptive Platform Trial Protocol: New Tools for an Old Foe. Clin Infect Dis. 2022 Nov 30;75(11):2027-2034. doi: 10.1093/cid/ciac476.

    PubMed 35717634

  • Symons TJ, Straiton N, Gagnon R, Littleford R, Campbell AJ, Bowen AC, Stewart AG, Tong SYC, Davis JS. Consumer perspectives on simplified, layered consent for a low risk, but complex pragmatic trial. Trials. 2022 Dec 28;23(1):1055. doi: 10.1186/s13063-022-07023-z.

    PubMed 36578070

  • Malhame I, Hardy E, Cheng MP, Tong SY, Bowen AC. Walking the walk to include pregnant participants in non-obstetric clinical trials: Insights from the SNAP Trial. Obstet Med. 2023 Mar;16(1):3-4. doi: 10.1177/1753495X231163351. Epub 2023 Mar 22. No abstract available.

    PubMed 37139509

  • Henderson A, Cheng MP, Chew KL, Coombs GW, Davis JS, Grant JM, Gregson D, Giulieri SG, Howden BP, Lee TC, Nguyen V, Mora JM, Morpeth SC, Robinson JO, Tong SYC, Van Hal SJ; Microbiology Working Group of the Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group. A multi-site, international laboratory study to assess the performance of penicillin susceptibility testing of Staphylococcus aureus. J Antimicrob Chemother. 2023 Jun 1;78(6):1499-1504. doi: 10.1093/jac/dkad116.

    PubMed 37071589

  • de Kretser D, Mora J, Bloomfield M, Campbell A, Cheng MP, Guy S, Hensgens M, Kalimuddin S, Lee TC, Legg A, Mahar RK, Marks M, Marsh J, McGlothin A, Morpeth SC, Sud A, Ten Oever J, Yahav D, Bonten M, Bowen AC, Daneman N, van Hal SJ, Heriot GS, Lewis RJ, Lye DC, McQuilten Z, Paterson DL, Owen Robinson J, Roberts JA, Scarborough M, Webb SA, Whiteway L, Tong SYC, Davis JS, Walls G, Goodman AL; SNAP Early Oral Switch Domain-Specific Working Group and SNAP Global Trial Steering Committee; SNAP Trial Group. Early Oral Antibiotic Switch in Staphylococcus aureus Bacteraemia: The Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Early Oral Switch Protocol. Clin Infect Dis. 2024 Oct 15;79(4):871-887. doi: 10.1093/cid/ciad666.

    PubMed 37921609

  • Mahar RK, McGlothlin A, Dymock M, Lee TC, Lewis RJ, Lumley T, Mora J, Price DJ, Saville BR, Snelling T, Turner R, Webb SA, Davis JS, Tong SYC, Marsh JA; SNAP Global Trial Steering Committee. A blueprint for a multi-disease, multi-domain Bayesian adaptive platform trial incorporating adult and paediatric subgroups: the Staphylococcus aureus Network Adaptive Platform trial. Trials. 2023 Dec 6;24(1):795. doi: 10.1186/s13063-023-07718-x.

    PubMed 38057927

  • Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group. Benzylpenicillin versus flucloxacillin or cloxacillin for the treatment of penicillin-susceptible Staphylococcus aureus bacteraemia (SNAP): an international, multicentre, open-label, non-inferiority randomised controlled trial. Lancet. 2026 Jul 11;408(10550):141-152. doi: 10.1016/S0140-6736(26)00761-0. Epub 2026 Jun 17.

    PubMed 42309115

  • Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group; Lee TC, Barina LA, Walls G, Goodman AL, Yahav D, Cheng MP, Bonten M, Bowen AC, Boyles T, Daneman N, Ekkelenkamp MB, Ghanem-Zoubi N, Hensgens MPM, Jager NGL, Kaasch AJ, Kouijzer IJE, Lewis RJ, Lumley T, Lye DC, McDonald EG, McKew G, McLean ARD, McMullan BJ, McQuilten ZK, Morpeth SC, Paterson DL, Roberts JA, Robinson JO, Saito H, Scarborough M, Ten Oever J, Turner RM, Tverring J, van Hal SJ, Webb SA, Whiteway LM, Arias CA, Henderson A, Heriot GS, Snelling TL, Afra K, Ali SS, Amit S, Anagnostou NA, Archuleta S, Aston SJ, Athan E, Baharav N, Bai AD, Barber BE, Baskaran A, Berkeley MMA, Best EJ, Bhilave NR, Bloomfield MG, Bond KA, Bostock J, Botheras CL, Boyd MA, Bradshaw SME, Briggs EJ, Britton PN, Campbell AJ, Carr BZ, Chancellor JA, Chen K, Cheong EY, Chew KL, Chia PY, Chomba R, Chong BSW, Clews CJN, Cohen JM, Commons RJ, Cutfield T, Daley P, Daniel DS, Davies J, De P, Denholm JT, Di Virgilio M, Dishon-Benattar Y, Dotel R, Duan EH, Easom N, Eliakim-Raz N, England MM, Fahmy M, Findlater AR, Flanagan KL, Foo EZJ, Foo H, Forster DP, Fralick M, Frazer JL, Gador-Whyte AP, Garnham K, German GJ, Ghosh N, Gisolf EH, Giulieri SG, Goulding SR, Grant JM, Gregson D, Grimwade KC, Grupper M, Guy SD, Gwee A, Hall VG, Hardy EJ, Harris DJ, Hatcher J, Hobbs MR, Holmes NE, Howden BP, Huggan PJ, Jennings ZA, Johnstone J, Juniper T, Kalimuddin S, Kamfose M, Kandel C, Kelly MJ, Kozak RA, Kumin M, Lamontagne F, Lau JSY, Lee IR, Lin RJ, Lindsay D, Llewelyn MJ, Longtin Y, Lother SA, Luey CE, MacFadden DR, Mahony AA, Malden C, Malhame I, Manning LA, Marks M, Martin LJ, Matthews GV, McGann PH, McMahon JH, Melon A, Menon V, Mertz D, Meyer MP, Molton JS, Mora JM, Moran E, Mortimer LM, Motaganahalli S, Muller MP, Munro APS, Murray FA, Murthy S, Nagendra V, Nel H, New DWJ, Nguyen V, Norton G, Norton KM, Nourse CB, Nye CJS, O'Callaghan K, O'Sullivan MVN, Ong SWX, Otu AA, Owen M, Papenburg J, Parkes LO, Paul M, Perez-Patrigeon S, Petersiel N, Petrella L, Pett SL, Pham D, Piazzese CJ, Poulin S, Rehak R, Rennert-May E, Richards AJ, Rogers BA, Sahng E, Salada B, Scheuerman O, Schneider K, Schulz TR, Schwartz KL, Simos PA, Singh H, Sinkeler FS, Smith S, Smith BJ, Smith SW, Somayaji R, Sommerville C, Song RXJ, Sowden DC, Stark MJ, Stone NRH, Strunk T, Sud A, Swe KP, Symons CR, Tan YE, Ten Doesschate T, Thien SY, Thomas A, Trad MA, Tramontana AR, Tsang JLY, Ulett K, Underwood J, van Welzen BJ, Vazquez-Grande G, Velasquez Reyes DC, Verberk JDM, Voss LM, Ward D, Webb RH, Whitmore TJ, Wieder-Finesod A, Wilson HL, Wilson EW, Wong HM, Wong She K, Wuerz T, Yamamura DL, Yeoh A, Yow BLH, Dymock M, Mahar RK, McGlothlin A, Marsh JA, Davis JS, Tong SYC. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia. N Engl J Med. 2026 Jun 18;394(23):2329-2339. doi: 10.1056/NEJMoa2506905.

    PubMed 42308484

  • Shah S, Clarke LG, Falcione BA, Shields RK, Smith BJ. Incidence and factors associated with rapid blood culture sterilization among patients receiving ertapenem combination therapy for MSSA bacteremia. Antimicrob Agents Chemother. 2026 Feb 4;70(2):e0130325. doi: 10.1128/aac.01303-25. Epub 2025 Dec 23.

    PubMed 41433510

  • Mahar RK, McGlothlin A, Dymock M, Barina L, Bonten M, Bowen A, Cheng MP, Daneman N, Goodman AL, Lee TC, Lewis RJ, Lumley T, McLean ARD, McQuilten Z, Mora J, Paterson DL, Price DJ, Roberts J, Snelling T, Tverring J, Webb SA, Yahav D, Davis JS, Tong SYC, Marsh JA; SNAP Global Trial Steering Committee. Statistical documentation for multi-disease, multi-domain platform trials: our experience with the Staphylococcus aureus Network Adaptive Platform trial. Trials. 2025 Feb 11;26(1):49. doi: 10.1186/s13063-024-08684-8.

    PubMed 39934879

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Cefazolin, Penicillin and Clindamycin in people with Staphylococcus Aureus Bacteremia, run by University of Melbourne at 161 sites in 13 countries.

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 18 inclusion and 41 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: looking for participants now, as of the sponsor's last update on 6 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 161 sites in Australia, Canada, United Kingdom, New Zealand, Netherlands and 8 more countries. 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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Lauren Barina (+61 (03) 8344 1623, lauren.barina@unimelb.edu.au), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

All-cause mortality at 90 days after platform entry (time frame: From randomisation (day 1) until day 90). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05137119, which also lists 10 linked publications.

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 6 May 2026.

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