Beta-Lactam InfusioN Group Study (BLING III)
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|ClinicalTrials.gov Identifier: NCT03213990|
Recruitment Status : Active, not recruiting
First Posted : July 11, 2017
Last Update Posted : January 25, 2023
The purpose of this study is to find out whether continuous infusion of beta-lactam antibiotics or intermittent infusion or beta-lactam antibiotics, offers more health advantages to patients or if there is no difference.
The investigators will be looking to see whether patients receiving beta-lactams via one administration method or the other have a better chance of recovering from their illness. They will also be looking at long term outcomes such as quality-of-life and healthcare resource use.
Sepsis is caused by toxic substances (toxins) from bacteria and other organism entering the bloodstream from a site of infection. In some people, the infection can progress to sepsis and septic shock where the functions of organs in the body are affected. Patients suffering from sepsis and septic shock are commonly managed in the intensive care unit (ICU) where they are prescribed antibiotics as standard therapy, as well as other therapies to support the functions of the body.
Beta-lactam antibiotics are a group of antibiotics commonly used to treat infection in patients with sepsis and septic shock.
Currently, beta-lactam antibiotics are most commonly given to patients be intermittent infusions, that is, given at regular intervals throughout 24 hours. New research suggests that giving beta-lactam antibiotics as a continuous infusion may mean that antibiotic concentrations in the blood remain more consistent and may be more effective at killing bacteria.
However, the benefit to the patient by giving beta-lactams via continuous infusion has not been tested in a high-quality, large clinical trial.
|Condition or disease||Intervention/treatment||Phase|
|Sepsis||Other: Continuous infusion Other: Intermittent infusion||Not Applicable|
Aim To conduct a multicentre randomised, controlled trial (RCT) to determine whether continuous infusion of a beta-lactam antibiotic (piperacillin-tazobactam or meropenem) results in decreased all cause Day 90 mortality compared with intermittent beta-lactam antibiotic infusion in critically ill patients with sepsis.
Hypothesis The BLING III Study will test the hypothesis that patients managed in the ICU with sepsis, the administration of beta-lactam antibiotics via continuous infusion decreases Day 90 mortality compared with intermittent infusion Design This BLING III study is a prospective, multicentre, open, phase III, RCT. Participants commenced on one of two beta-lactam antibiotics (piperacillin-tazobactam or meropenem) will be randomised to receive the beta-lactam antibiotic via either continuous infusion or intermittent infusion over 30 minutes for the treatment course while in the ICU for up to 90 days after randomisation. For participants where the beta-lactam antibiotic is subsequently changed from piperacillin-tazobactam to meropenem or vice versa for ongoing treatment of the infectious episode, the new prescription will continue to be administered in the allocated method (continuous infusion or intermittent infusion over 30 minutes).
Permuted block randomisation with variable block sizes and stratified by site will be conducted via a password-protected, secure web-based interface.
The primary endpoint for this trial will be death from all causes at 90 days.
7,000 patients will be enrolled into this study from approximately 70 ICUs worldwide, with approximately 35 ICUs in Australian and New Zealand hospitals.
For eligible patients, the administration method of beta-lactam antibiotic, either piperacillin-tazobactam or meropenem, will be randomised to either continuous infusion or intermittent infusion over 30 minutes. The choice of beta-lactam antibiotic and the dose and dosing interval (i.e. the dose the patient will receive in 24 hours) will be determined by the treating physician prior to randomisation.
For all patients, data will be collected at baseline and daily whilst in the ICU. Patients will be followed up to day 14, regardless of location in the hospital, to determine test of cure and to identify new acquisition, colonisation or infection with an multi-resistant organism. Additional follow up will occur at 90 days post randomisation.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||7203 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||A Phase III Randomised Controlled Trial of Continuous Beta-lactam Infusion Compared With Intermittent Beta-lactam Dosing in Critically Ill Patients|
|Actual Study Start Date :||March 26, 2018|
|Estimated Primary Completion Date :||April 2023|
|Estimated Study Completion Date :||June 2023|
The prescribed Beta-lactam is administered by a continuous infusion.
Other: Continuous infusion
Clinician prescribed beta-lactam antibiotic will be administered via continuous infusion for as long as prescribed whilst in the ICU
the prescribed Beta-lactam is administered by intermittent infusion over 30 minutes
Other: Intermittent infusion
Clinician prescribed beta-lactam antibiotic will be administered via intermittent infusion for as long as prescribed whilst in the ICU
- All-cause mortality [ Time Frame: 90 Days after randomisation ]Patient mortality status assessed at 90 days after randomisation
- Clinical Cure [ Time Frame: Day 14 post randomisation ]
Clinical cure will be defined as the completion of the beta-lactam antibiotic treatment course (on or prior to Day 14) without recommencement of antibiotic therapy within 48 hours of cessation.
Participants discharged from hospital within 14 days following randomisation will be considered to meet the definition of clinical cure. Participants who decease while receiving the antibiotic treatment course or where antibiotic therapy is ceased in the setting of death being deemed imminent and inevitable, will be assessed as not meeting the criteria for clinical cure.
- New acquisition, colonisation or infection [ Time Frame: up to 14 days post randomisation or hospital discharge, whichever is sooner ]New acquisition, colonisation or infection with an Multi-resistant organism (MRO) or Clostridium difficile diarrhoea
- All cause ICU mortality [ Time Frame: up to 90 days ]Patient mortality status assessed at ICU discharge
- All cause hospital mortality [ Time Frame: up to 90 days ]Patient mortality status assessed at hospital discharge
- ICU length of stay [ Time Frame: up to 90 days ]Patient assessment of time spent in the ICU
- Hospital length of stay [ Time Frame: up to 90 days ]Patient assessment of time spent in hospital.
- Quality of life [ Time Frame: 90 days after randomisation ]Quality of life measured with the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L)
- Health services use [ Time Frame: up to 90 days after randomisation ]Additional follow up at Day 90 for the purpose of economic evaluation will be conducted for Australian, New Zealand and sites from participating regions only. Follow up at Day 90 will include recording readmission to hospital and ICU within 90 days and will assess quality of life and functional capacity using the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L) questionnaire (if not deceased).38 The consent document used at participating sites will detail the inclusion of a quality of life questionnaire at Day 90.
- Cost effectiveness analysis [ Time Frame: up to 90 days ]A cost-effectiveness analysis at 90 days following randomisation will be conducted as a nested cohort in Australian, New Zealand and other potential regional sites. Cost data will be derived from health care utilisation to Day 90, estimated through standard per diem ICU and hospital costs. The analysis will be conducted from a health care payer perspective, comparing health care utilisation costs and quality-adjusted life years gained (measured by the EQ-5D-5L) between treatment arms. Where feasible, the cost-effectiveness analysis will be conducted in other country-specific regions. Depending on the outcome from the primary trial, several further analyses are planned including a longer-term cohort study and a modelled economic evaluation. The BLING III cost-effectiveness analysis will be informed by a separate Statistical Analysis Plan.
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): NCT03213990
|Study Chair:||Jeffrey Lipman||The George Institute|