Infection, Sepsis
Conditions
Keywords
Beta-lactam antibiotics, Sepsis, Septic shock, Pharmacokinetics, Personalized medicine, Therapeutic drug monitoring, Infectious disease
Brief summary
The goal of this study is to compare two different ways of dosing cefepime, an antibiotic for very sick patients - the usual approach to dosing or a new dosing method. The new dosing method uses only doses that are available in normal care, but choosing between the different doses is based on more information about the patient's body including their kidney function. The primary purpose of this study is to test how easy it is for healthcare professionals to use the new dosing method and how best to conduct the trial. The study will also assess if the new dosing method helps patients recover faster and reduces side effects.
Interventions
OTHERUp-front individualized dosing algorithm
An individualized cefepime dosing algorithm will be used to determine the cefepime dose and interval. The dose recommendation will be provided using the EHR-prompts to the clinical care team and ordered and/or verified by the ICU pharmacist using an established collaborative practice agreement. As a pragmatic trial, at any point care teams may modify the empiric or subsequent dose based on their clinical judgement.
OTHERUsual Care
The standard of care group will receive empiric dosing guided by an institutional antimicrobial guide. Cefepime is typically dosed at 0.5-2 g every 8-24 h according to categorical thresholds of estimated creatinine clearance (eGFRcr). Cystatin C and eGFRcr-cys can be calculated and used at clinicians' discretion to aid in drug dose determination.
Sponsors
Mayo Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults ≥18 years of age * Admitted to one of the ICUs at the study center * Prescribed cefepime therapy by the care team
Exclusion criteria
* Individuals will be those with a cephalosporin allergy * Received \>1 dose of cefepime in the 24 hours before ICU admission * Transferred from an external hospital without compatible EHR * Does not have a cystatin C and a creatinine available for drug dosing * Acute kidney injury stage 2 or higher * Receiving renal replacement therapy * Treated with extracorporeal membrane oxygenation * Undergoing molecular adsorbent recirculating therapy at the time of beta-lactam initiation * Pregnant * Incarcerated * Declined Minnesota research authorization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients screened who qualified for the study | 1 year or once the sample size is achieved | Number of patients who quality for the study out of total number of patients screened, reported as a percentage |
| Distribution of qualified patients across care teams | 1 year or once the sample size is achieved | Number of patients from each ICU care team who qualify for the study |
| Adherence to dosing recommendations | 1 year or once the sample size is achieved | Total number of patients randomized to the up-front individualized dosing algorithm who are prescribed the algorithm's recommended dosage |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of antibiotic-free days | 28-days | Number of antibiotic-free days for the first 28 days |
| ICU length of stay | 1 year | Number of days of initial ICU stay |
| Proportion of patients who experience new anti-Pseudomonal beta-lactam resistance | 6 months | New anti-Pseudomonal beta-lactam resistance which develops within the 6 months following initial treatment |
| Proportion of patients who experience clinical success | 8 days | Complete or partial resolution of clinical signs and symptoms attributed to infection across 8 days of therapy. |
| Proportion of patients who experience microbiologic success | 8 days | Presumed or documented eradication of causative microorganisms |
| Mortality | 28-days | All cause death |
Countries
United States
Contacts
CONTACTGerald W. Flaby Jr., LRT, RRT
PRINCIPAL_INVESTIGATORErin Barreto, PharmD, PhD
Mayo Clinic
Outcome results
None listed