Hemolytic-Uremic Syndrome
Conditions
Keywords
Shiga-Toxigenic Escherichia coli, Child
Brief summary
This study will provide feasibility data regarding the conduct of a clinical trail evaluating the use of early aggressive inpatient intravenous rehydration in children with Shiga Toxin producing E. coli infection.
Detailed description
Background: Shiga toxin-producing Escherichia coli (STEC) cause a spectrum of disease, ranging from asymptomatic carriage to bloody diarrhea and the hemolytic uremic syndrome (HUS). HUS is caused by a toxin that destroys red blood cells, consumes platelets and impairs kidney function. HUS results in morbidity and even death in otherwise healthy children. Over the last 30 years however, there has been extremely limited progress in preventing acute and long-term complications in children with STEC infection. However, it is believed that Shiga toxins generate clots or blockages in the kidneys that damage it much the way strokes cause brain damage. There is emerging evidence that if children with STEC infection are recognized early, then the interval between diarrhea onset and the presence of HUS could be exploited to preserve kidney function through the use of intravenous rehydration. Study Design: The investigators propose to conduct the first randomized clinical trial of volume expansion therapy in children with STEC infection. Employing Alberta's unique province-wide microbiology network and its only two pediatric tertiary care centres, the investigators will conduct a proof of principal feasibility study that evaluates novel technologies to identify STEC infected children and those at risk for HUS. Objectives: The primary outcome will be process: number of children recruited. Secondary outcomes will include: 1) resources: retention; refusal; compliance; eligibility criteria; questionnaires; data collection tools; and time requirements; 2) management: capacity and impact on clinical services; 3) scientific: utility of point-of-care STEC diagnostics; use of urine biomarkers to identify high risk children, monitoring of kidney injury and response to therapy; and safety. Significance: This pilot will provide the necessary data to integrate novel technologies into the design and conduct of a multicentre, multinational, clinical trial that will reduce morbidity and mortality from STEC infection.
Interventions
DRUGD5-0.9%NS
Admission for intravascular volume expansion
DRUGRoutine home oral rehydration
Routine oral fluids as is given at home to all children with acute diarrheal disease
Sponsors
University of Calgary
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
6 Months to 18 Years
Healthy volunteers
No
Inclusion criteria
1. Age \<18.0 years; 2. STEC infection \[positive culture OR antigen OR polymerase chain reaction test for Stx/gene\]; 3. Day of illness 1-10: Children who develop HUS will do so by day #14 of illness;8 restricting enrolment to the first 10 days will ensure all participants are at risk of HUS.
Exclusion criteria
1. Evidence of evolving HUS: A) Hematocrit \<30% OR B) Platelet count \<150 x 109/L; 2. Responsible physician desires patient admission (therefore unable to randomize); 3. Unable to contact family within 48 hours of positive stool test; 4. Patient with history of atypical HUS; 5. Chronic disease limiting fluid volumes administered (e.g. impaired cardiac function)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of children enrolled in the study protocol | at the end of the 24 month study recruiting period | The number of children recruited per month per site will be calculated and will be related to the number screened, number eligible, and number consented. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The proportion of children enrolled in each study arm who develop adverse events | at the end of the 24 month study recruiting period | For participants enrolled in each study arm we will quantify the proportion that are admitted to Intensive Care Units, the proportion requiring respiratory support (CPAP, BiPAP, endotracheal intubation), hypoxia defined by the administration of supplemental oxygen, and evidence of congestive heart failure defined by blinded independent reviewers. |
| Retention | at the end of the 24 month study recruiting period | The proportion of children who complete the study protocol |
| Time requirements | at the end of the 24 month study recruiting period | We will quantify the number of hours children remain admitted and to which clinical units |
| Child/family perspectives | at the end of the 24 month study recruiting period | 7-item likert scales will be employed to evaluate perspectives of parents and participants as appropriate related to study protocols, procedures and participation |
| Impact on clinical services | at the end of the 24 month study recruiting period | We will qualitatively explore with the department leads at the respective institutions if the study protocol had any impact on clinical care provided either to the admitted patients or to other patients on their services |
| Cost | at the end of the 24 month study recruiting period | We will quantify the costs per child in each study arm |
| compliance/adherence | at the end of the 24 month study recruiting period | The proportion of children enrolled in each study arm who comply with the key interventions of the respective study arms |
| data collection tool performance | at the end of the 24 month study recruiting period | Individual data fields will be audited with respect to data quality, reliability, completeness, timeliness of completion |
Other
| Measure | Time frame | Description |
|---|---|---|
| Point-of-Care STEC diagnosis | at the end of the 24 month study recruiting period | diagnostic accuracy compared with standard culture |
| Urine biomarkers | at the end of the 24 month study recruiting period | ability to predict progression to AKI and HUS |
Countries
Canada
Outcome results
None listed