Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial.

Autor:	Peel T; Infectious Diseases, Monash University, Melbourne, Victoria, Australia Trisha.Peel@monash.edu.; Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia., Astbury S; Infectious Diseases, Monash University, Melbourne, Victoria, Australia., Cheng AC; Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia.; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia., Paterson D; Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.; Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia., Buising K; Medicine, University of Melbourne, Melbourne, Victoria, Australia.; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia., Spelman T; Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia., Tran-Duy A; Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia., de Steiger RS; Surgery, The University of Melbourne, Melbourne, Victoria, Australia.; Orthopaedics, Epworth HealthCare, Richmond, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2019 Nov 03; Vol. 9 (11), pp. e033718. Date of Electronic Publication: 2019 Nov 03.
DOI:	10.1136/bmjopen-2019-033718
Abstrakt:	Introduction: Resistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established. Methods and Analysis: This randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis. Ethics and Dissemination: The study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums. Trial Registration Number: ACTRN12618000642280. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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