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Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) (PARITY)

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ClinicalTrials.gov Identifier: NCT01479283
Recruitment Status : Completed
First Posted : November 24, 2011
Last Update Posted : March 11, 2021
Sponsor:
Collaborators:
Orthopedic Research and Education Foundation
The Physicians' Services Incorporated Foundation
Canadian Cancer Society (CCS)
Canadian Institutes of Health Research (CIHR)
Information provided by (Responsible Party):
Michelle Ghert, MD, FRCSC, McMaster University

Study Description
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Brief Summary:
The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial is the first ever international multi-center randomized controlled trial in bone cancer surgery. In order to avoid amputation for bone cancer in the leg, complex limb-saving operations are performed. However, infections with devastating complications following surgery are common. Surgeons from across the world will randomize patients to receive either short- or long-duration antibiotic regimens after surgery with the goal of identifying the best regimen to reduce these infections.

Condition or disease Intervention/treatment Phase
Infection Bone Neoplasms Drug: 24-Hour Prophylactic Cefazolin* Antibiotic Regimen Drug: 5-Days Prophylactic Cefazolin* Antibiotic Regimen Phase 3

Detailed Description:
Long-bone sarcomas were historically managed with amputation. In the current era of osteosarcoma management, amputations are generally avoided by complex surgeries in which the malignancy is removed and the limb is reconstructed with advanced surgical techniques. This process of limb salvage is possible with improvements in chemotherapeutic regimens, advanced imaging techniques and surgical innovations such as modular metallic implants. However, the risk for surgical complications is high due to the complexity of the surgeries themselves. The most common and devastating complication is a surgical site infection. Background work and data from our pilot study indicates that infection rates approach 15%. Multiple surgical attempts at eradication of the infection fail in 50% of these cases, resulting in amputation. Published guidelines for post-operative antibiotic prophylaxis following many standard and less complex elective surgical procedures dictate that prophylactic antibiotics be discontinued after 24 hours. However, the most effective duration of treatment in sarcoma surgery has not previously been examined. Given the limitations of the evidence, it has not been possible for orthopaedic oncologists to draw firm conclusions and, therefore, clinical practice is highly varied, particularly with respect to antibiotic duration. Our international, multi-center randomized controlled trial will determine whether a 5-day regimen of post-operative prophylactic antibiotics in comparison to a standard 24-hour regimen decreases the rate of surgical site infections after limb salvage surgery within 1-year follow-up.
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 602 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY): A Multi-Center International Randomized Controlled Trial Comparing Alternative Antibiotic Regimens in Patients Undergoing Tumor Resections With Endoprosthetic Replacements
Actual Study Start Date : January 2013
Actual Primary Completion Date : March 2021
Actual Study Completion Date : March 2021

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Arms and Interventions
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Arm Intervention/treatment
Active Comparator: Short-Arm Antibiotic Regimen

Intervention: 24-Hour Prophylactic Cefazolin* Antibiotic Regimen

*or another cephalosporin with equivalent gram-positive coverage in centers where cefazolin is not routinely used or not approved for use

 Drug: 24-Hour Prophylactic Cefazolin* Antibiotic Regimen

Pre-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin within 60 minutes prior to the procedure. No other pre-operative antibiotics will be administered.

Intra-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 3-4 hours. No other intra-operative antibiotics will be administered.

Post-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 8 hours for 24 hours followed by IV saline for 4 days. No other post-operative antibiotics will be administered.

Other Name: ANCEF ®
Experimental: Long-Arm Antibiotic Regimen

Intervention: 5-Days Prophylactic Cefazolin* Antibiotic Regimen

*or another cephalosporin with equivalent gram-positive coverage in centers where cefazolin is not routinely used or not approved for use

 Drug: 5-Days Prophylactic Cefazolin* Antibiotic Regimen

Pre-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin within 60 minutes prior to the procedure. No other pre-operative antibiotics will be administered.

Intra-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 3-4 hours. No other intra-operative antibiotics will be administered.

Post-Operative Antibiotic Regimen: Patients will receive 2g (or a weight-based dose based on 100mg/kg/day with a maximum single dose of 2g if < 18 years old) of IV cefazolin every 8 hours for 5 days. No other post-operative antibiotics will be administered.

Other Name: ANCEF ®


Outcome Measures
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Primary Outcome Measures :
  1. Surgical Site Infections [ Time Frame: 1 year ]
    the development of a surgical site infection according to the criteria established by the Center for Disease Control (CDC)


Secondary Outcome Measures :
  1. Functional Outcome and Quality of Life [ Time Frame: 1 year ]
    as measured by the Musculoskeletal Tumor Society (MSTS) functional score (1987 and 1993 versions) and the Toronto Extremity Salvage Score (TESS) questionnaires

  2. Antibiotic-Related Complications [ Time Frame: 1 year ]
    examples of antibiotic-related complications include gastrointestinal infections, fungal infections, etc.

  3. Rate of Re-Operation [ Time Frame: 1 year ]
    re-operation may be required if patients develop a surgical site infection

  4. Oncologic Recurrence and/or Metastases [ Time Frame: 1 year ]
  5. Mortality [ Time Frame: 1 year ]

Eligibility Criteria
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Ages Eligible for Study:   12 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • primary bone malignancies or aggressive benign bone tumors of the femur or tibia, soft-tissue sarcomas which have invaded the femur or tibia, or oligometastatic bone disease of the femur or tibia in a patient expected to live at least one year post-operatively; and
  • treatment by surgical excision and endoprosthetic replacement of the femur or tibia.

Exclusion Criteria:

  • current known Methicillin-resistant Staphylococcus Aureus (MRSA) colonization;
  • current known Vancomycin Resistant Enterococcus (VRE) colonization;
  • documented anaphylaxis or angioedema to penicillin or cefazolin (Ancef);
  • current surgical procedure is a revision surgery for implant failure or infection;
  • prior local infection within the surgical field of the affected limb;
  • current known immunologically-deficient disease conditions (not including recent chemotherapy);
  • known renal insufficiency with estimated creatinine clearance (eGRF) of less than 54 mL/min;
  • reconstruction to include structural allograft;
  • enrolled in a competing study; and
  • weight of less than or equal to 45 kg (for sites using cefuroxime only).
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01479283


Locations
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Sponsors and Collaborators
McMaster University
Orthopedic Research and Education Foundation
The Physicians' Services Incorporated Foundation
Canadian Cancer Society (CCS)
Canadian Institutes of Health Research (CIHR)
Investigators
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Principal Investigator: Michelle Ghert, MD, FRCSC McMaster University
More Information
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Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Michelle Ghert, MD, FRCSC, Professor | Department of Surgery, McMaster University
ClinicalTrials.gov Identifier: NCT01479283    
Other Study ID Numbers: GHRT01
First Posted: November 24, 2011    Key Record Dates
Last Update Posted: March 11, 2021
Last Verified: March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by Michelle Ghert, MD, FRCSC, McMaster University:
Infection
Bone Neoplasms
Prosthesis
Anti-Bacterial Agents
Randomized
Additional relevant MeSH terms:
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Bone Neoplasms
Neoplasms
Neoplasms by Site
Bone Diseases
Musculoskeletal Diseases
 Anti-Bacterial Agents
Cefazolin
Antibiotics, Antitubercular
Anti-Infective Agents
Antitubercular Agents