Bundle of Coated Devices to Reduce Nosocomial Infections in the Intensive Care Unit. CRITIC Pilot Randomized Controlled Trial

Fernando G. Zampieri, Neymar Elias De Oliveira, Antonio Paulo Nassar, Airton Leonardo De Oliveira Manoel, Cintia Grion, F. Abio H. Lacerda, Israel Maia, Marlus Thompson, Thiago Simões Giancursi, Priscilla De Aquino Martins, Thiago Lisboa, Tamiris Abait, Lucas P. Damiani, Fl Avia R. MacHado, Alexandre B. Cavalcanti, for the BRICNet

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

Rationale: Coated devices may reduce biofilm formation and reduce the occurrence of device-related infections in critically ill patients. A bundle of coated devices (an endotracheal tube [ETT], central venous catheter [CVC], and urinary catheter [UC]) simultaneously inserted may optimize benefits of coated devices in patients with the most severe illness. Objectives: To assess the feasibility of a randomized controlled trial on simultaneous insertion of gold/silver/palladium-coated devices versus uncoated devices in severely ill patients, which required sequential insertion of all three devices (an ETT, CVC, and UC) for support in the intensive care unit (ICU). Methods: This was a multicenter randomized controlled pilot trial. Patients who required simultaneous insertion of an ETT, CVC, and UC were randomized to treatment with coated versus uncoated devices, which were used as necessary for up to 28 days. The primary endpoint was feasibility, defined as the trial being able to enroll enough participants to have the sample size necessary for its secondary primary endpoint (estimating sepsis incidence in this population) in less than 1 year and for estimating the number of admitted patients who require simultaneous insertion of all three devices. Secondary endpoints included the incidence of sepsis and device-associated infections (ventilator-associated pneumonia, catheter-related bloodstream infection, and catheter-related urinary-tract infection) within each group as well as the number of days alive and free of antibiotics during the ICU stay. All events were adjudicated. Results: One hundred and three patients (48 in the coated-device group and 55 in the uncoated-device group) were included in the perprotocol analysis. The inclusion period was 8 months. There were 13 septic events in each group (26 in total), with an approximate incidence of sepsis of 32.3 (95% credible interval [CrI], 22.4-44.9) per 100 patient-days. The overall incidences of ventilator-associated pneumonia, catheter-related urinary-tract infection, and catheterrelated bloodstream infection were 15.2 (95% CrI, 7.8-26.4), 6.3 (95% CrI, 2.4-13.7), and 7.9 (95% CrI, 3.6-15.1) per 1,000 patient-days, and incidence rates were not statistically different between groups. Patients in the coated-device group had more days alive and free of antibiotics in the ICU (28.97 d vs. 19.62 d per 100 patient-days; mean ratio, 1.48; 95% CrI, 1.16-1.89). Conclusions: Use of a bundle of coated devices as the initial treatment for of severely ill patients is feasible. Coated devices may be associated with more days alive and free of antibiotics. Clinical trial registered with www.clinicaltrials.gov (NCT 03868241).

OriginalsprogEngelsk
TidsskriftAmerican Thoracic Society. Annals (Online)
Vol/bind17
Udgave nummer10
Sider (fra-til)1257-1263
ISSN2325-6621
DOI
StatusUdgivet - okt. 2020

Bibliografisk note

Funding Information:
Supported by Bactiguard. This is an investigator-initiated trial. The investigators (F.G.Z. and A.B.C.) proposed the trial in its form to the sponsor (Bactiguard). The sponsor reviewed and agreed on the design and endpoints. The sponsor was not involved in any aspect of the trial other than funding and supplying of devices and did not have access to individual patient data or participate in the decision to publish the results. As per the contractual agreement, the sponsor received a version of this manuscript before submission and agreed with its contents.

Publisher Copyright:
© 2020 American Thoracic Society. All rights reserved.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

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