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Completed

NCT Number: NCT02265406

PROPHY-VAP: Prevention of Early Ventilation Acquired Pneumonia (VAP) in Brain Injured Patients by a Single Dose of Ceftriaxone

Ventilation-associated pneumonia (VAP) is the main site of healthcare-associated infections in the brain injured patients, with an incidence rate of 22% to 58%. VAP increases morbi-mortality, length of stay in intensive care and overall management costs. The prevention of ICU nosocomial infections depends on several measures : orotracheal intubation route, maintaining tube cuff pressure between 25 and 30 cm of water (H2O), maintaining a semi-seated position >= 30°, nasal and oropharyngeal care at regular intervals, striving to avoid unscheduled extubation, and use of a written sedation-analgesia algorithm allowing for early weaning from ventilation. Two randomized study show that administration of antibiotic therapy after intubation reduces the risk of early VAP incidence. However, in clinical practice, its administration solely purposes of limiting VAP occurence is not presently recommended. Indeed, to date no placebo blind controlled study was been realized and the fear of development of bacterial resistance remains stronger than the efficiency of this prevention measure. This aim of the present study is to show by a placebo randomized study that 2g of Ceftriaxone within 8 hours post-intubation after a brain injury decrease the risk of occurence an early VAP.

Ancillary study An ancillary study is performed in 2 centres which routinely practice rectal swabs at admission and discharge of ICU, to survey intestinal flora (CHU of Angers and CHU of Rennes). The goal of this study is to compare the incidence of acquired cephalosporin resistant gram negative bacteria at the discharge of ICU between the 2 groups of patients, receiving or not ceftriaxone.

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Key information

Conditions

Early Ventilation Acquired Pneumonia in Brain Injured Patients

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

University Hospital of Angers, Angers, France

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Brain injured patients with a Glasgow scale score ≤ 12 who require ventilation more than 48 hours

Exclusion criteria

  • Patient with a high risk of death within the 48 first hours after admission,
  • Patient intubated for more than12 hours
  • Intubation after the 48th hours after admission
  • Coverage to cardiopulmonary arrest
  • Coma due to a tumor, an infectious disease or a cardiac arrest
  • Previous hospitalisation within the last month before admission for coma
  • béta-lactamines allergy
  • Patient who receive already antibiotics at the admission for a previous infection
  • Prophylactic antibiotic due to be done within 24 hours following the randomisation
  • Patient Intubated through a tracheal tube with subglottic secretion aspiration
  • Patient with a tracheotomy
  • Patient or family refuse to be involved in the study
  • Use of Ceftriaxone within 2 days before enrolment
  • Participation in another research protocol focusing on an anti-infective treatment or on a measure decreasing the risk of infection
  • Patients not affiliated to a social security scheme, Pregnant woman or breast-feeding mother, Patients deprived of their liberty by judicial or administrative decision

Treatment and study plan

Anti-Infective Agents

Drug

Placebo

Drug

Primary outcomes

  1. Incidence of early VAP, proportion of patients who develop a VAP within the 7 first day after mechanical ventilation (the 7th day included), confirm with microbiological culture, within all included patients.

    Time frame: 30 months

Secondary outcomes

  1. - Incidence of late VAP (> 7 jours)

    Time frame: 30 months

  2. - Global incidence of VAP during intensive care period (limited to day 60)

    Time frame: 30 months

  3. - Type of bacteria and their sensitivity for early or late VAP,

    Time frame: 30 months

  4. - Time between inclusion and occurence of the first VAP (limited to day 28),

    Time frame: 30 months

  5. - Length of the first period of mechanical ventilation during the intensive care period,

    Time frame: 30 months

  6. - Time between inclusion and the first spontaneous ventilation test (limited to day 28),

    Time frame: 30 months

  7. - Length of antibiotherapy during intensive care period,

    Time frame: 30 months

  8. - Length of intensive care, limited to 60 days,

    Time frame: 30 months

  9. - Length of stay in intensive care unit, limited to 60 days,

    Time frame: 30 months

  10. - Length of stay at the hospital, limited to 60 days,

    Time frame: 30 months

  11. - Neurological prognosis at the discharge of the intensive care unit,

    Time frame: 30 months

  12. - Mortality at day 28 and 60.

    Time frame: 30 months

  13. - Incidence of ventilated associated event (limited to day 60)

    Time frame: 30 months

  14. - Comparison of the global incidence of VAP according to the diagnosis defined by "American Thoracic Society" or by "Centers for Disease Control"

    Time frame: 30 months

Sponsors and collaborators

Lead sponsor

Poitiers University Hospital

Other

Registry information

Acronym: PROPHY-VAP

Important dates

Study start
2015
Primary completion
2020
Study completion
2020
First posted
Oct 15, 2014
Registry last updated
Feb 3, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.