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Ventilator Associated PneumoniaPhase 2CANTREATNCT00934934

Candida in the Respiratory Tract Secretions of Critically Ill Patients and The Efficacy of Antifungal Treatment

A Phase 2 study testing Normal Saline and anidulafungin in people with Ventilator Associated Pneumonia and Respiratory Tract Infection, run by Daren K. Heyland at 6 sites in Canada.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of the study is to determine whether the effect of treating Candida spp. isolated in the respiratory tract secretions of patients with a clinical suspicion of ventilator associated pneumonia (VAP) on clinical outcomes will be feasible and supported by biomarker data obtained. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Normal Saline and anidulafungin
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
61 participants
Where
6 sitesCanada
Study dates
Apr 2010to Aug 2012
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patients (>18 years old)
  • In the ICU > 48 hours
  • Mechanically ventilated (>48 hours)
  • Grow a Candida spp. on respiratory tract secretion culture (either by Bronchoalveolar Lavage or Endotracheal Aspirate) taken on or between 48 hours before or after the day of their suspicion of respiratory tract infection.
  • Develop a clinical suspicion of respiratory tract infection while ventilated as defined by the following criteria (as defined previously in our VAP trial)5:
  • The presence of new, worsening or persistent radiographic features suggestive of pneumonia without another obvious cause AND
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  • The presence of any two of the following:
  • Fever > 38C (core temperature)
  • Leukocytosis (>11.0 x109/L) or neutropenia (<3.5 x109/L)
  • Purulent endotracheal aspirates or change in character of aspirates
  • Isolation of pathogenic bacteria from endotracheal aspirates
  • Increasing oxygen requirements

Who cannot join

  • Patients not expected to be in ICU for more than 72 hours (due to imminent death, withdrawal of aggressive care or discharge).
  • Patients with Candida spp. in the blood or another sterile body site.
  • Patients colonized at other non-pulmonary body site(s) with Candida.
  • Already being treated with antifungal drugs (because of documented fungal infection, pre-emptive therapy, or prophylaxis).
  • Allergy to study drugs (Fluconazole or the Echinocandin on formulary at treating institution).
  • Immunocompromised patients (post-organ transplantation, Acquired Immunodeficiency Syndrome [AIDS], neutropenia [<1000 absolute neutrophils], corticosteroids [>20 mgs/day of prednisone or equivalent for more than 6 months]). These patients are excluded since Candida may be more invasive and these patients are much more likely to require systemic antifungal therapy.
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  • Patients with fulminant liver failure or end stage liver disease (Child's Class C).
  • Women who are pregnant or lactating.
  • Enrollment in industry sponsored interventional trial (co-enrollment in other academic studies would be allowed with the proviso that there was no potential interaction between the protocols).
  • Prior randomization in this study.

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

Canada6 sites
  • Hamilton Health Sciences Centre

    Hamilton, Ontario

  • Kingston General Hospital

    Kingston, Ontario, K7L 2V7

  • Hopital Maisonneuve-Rosemont

    Montreal, Quebec, H1T 2M4

  • Hopital du Sacre-Coeur do Montreal

    Montreal, Quebec, H4J 1C5

  • Ottawa General Hospital

    Ottawa, Ontario

  • Hopital l'Enfant-Jesus

    Québec, G1J 1Z4

Other trials in Canada

About this study

Official title: Candida in the Respiratory Tract Secretions of Critically Ill Patients and The Efficacy of Antifungal Treatment (The CANTREAT Study): A Prospective, Randomized, Double Blind, Placebo Controlled Pilot Study

The purpose of the study is to determine whether the effect of treating Candida spp. isolated in the respiratory tract secretions of patients with a clinical suspicion of ventilator associated pneumonia (VAP) on clinical outcomes will be feasible and supported by biomarker data obtained.

Read the detailed description

Candida spp. is commonly retrieved from microbiologic specimens of ICU patients with suspected VAP. It has been associated with increased systemic inflammation and worse clinical outcomes. This association may be due to the propensity for Candida to colonize those who are sicker, who have increased levels of systemic inflammation and worse clinical outcomes. However, an alternate possibility is that Candida is more than a colonizer and is responsible for the clinical and biochemical features observed. The only way to clarify the pathogenic role of Candida from this patient population is to treat the organism and see if patients improve compared to an untreated group. The purpose of this research program is to conduct such a study to determine if Candida in respiratory tract secretions should be routinely treated in critically ill patients. Since a definitive randomized controlled trial designed to demonstrate a reduction in mortality would be large, require the commitment of large amount of resources including both time and money, the investigators propose to first conduct a small pilot feasibility study.

Eligible patients will be randomized to receive antifungal treatment with anidulafungin or placebo. Following enrollment, study treatment (or placebo) will be started as soon as possible. When the Candida or yeast organisms have been speciated and/or a susceptibility profile is known, the study medication will be adjusted based on susceptibility patterns. The investigators propose to treat with antifungal therapy for a total of 14 days.

Patients will be followed daily for their entire stay in ICU or till day 28, whichever comes first. For patients discharged from the ICU to the ward, they will be followed until study treatment is complete (i.e. day 14). Mortality will be determined for the ICU stay, hospital stay and at 90 days. The investigators will record admission and discharge dates to ICU, step down units, and to hospital.

All patients will have 13 mL of blood/day drawn at baseline, day 3, day 8 and at the end of the treatment period on day 14 (or last day of treatment). The samples will be prepared on site and shipped to a central lab for processing. The investigators will use the blood specimens to measure markers of inflammation (C-reactive protein, Procalcitonin, and Interleukin-6 and others as determined by the investigators), markers of candida presence (b-glucan and other potential future markers) and markers of immune dysfunction (to be determined by investigators).

Being tested
Normal Saline, anidulafungin
Keywords
Candida, ventilator associated pneumonia, respiratory tract infection, antifungal, biomarker
Medical subject headings
Pneumonia, Ventilator-Associated, Respiratory Tract Infections, Torulopsis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Normal SalineOther

    Normal Saline

  • anidulafunginDrug

    Also called TBA

    TBA

Study groups in NCT00934934
Study groupRoleWhat they receive
PlaceboPlacebo comparatorSaline will serve as the placebo solution since the active comparator is clear and colourless.
Receives: Other: Normal Saline
AntifungalActive comparatorPatient will receive a dose daily for a total of 14 days
Receives: Drug: anidulafungin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Overall Recruitment Rate

    Overall recruitment rate per site

    Measured: 32 months

Secondary outcomes (10)
  1. Duration of Stay in ICU

    Measure of the duration of participant stay in the ICU

    Measured: 28 days

  2. Ventilator Free Days

    Number of days in ICU free of ventilation

    Measured: 28 days

  3. ICU Free Days

    Number of days free of ICU

    Measured: 28 days

  4. Antibiotic Free Days 28-day Post Randomization

    Number of days free of antibiotic use within the first 28 days

    Measured: 28 days

  5. Hospital Length of Stay

    Measure of the duration of the participant's hospital stay

    Measured: 90 days

  6. (SOFA) Post Randomization

    Sequential organ failure assessment. 0-24 The higher the number the more severe organ failure

    Measured: post randomization

  7. Sequential Procalcitonin

    Measured: 28 days

  8. C-reactive Protein

    Measured: 28 days

  9. Interleukin-6

    Measured: 28 days

  10. B-glucan Levels

    Measured: 28 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Jul 2009 (estimated)
  2. Study startApr 2010
  3. Primary completionAug 2012
  4. Study completionAug 2012

Why it stopped: slow enrollment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
61 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00934934
Sponsor's protocol ID
CANTREAT
Acronym
CANTREAT
Status last verified
Jan 2021
First submitted
7 Jul 2009
Last updated
1 Feb 2021
Data monitoring committee
No

Publications

  • Safdar N, Dezfulian C, Collard HR, Saint S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med. 2005 Oct;33(10):2184-93. doi: 10.1097/01.ccm.0000181731.53912.d9.

    PubMed 16215368
  • Muscedere JG, Martin CM, Heyland DK. The impact of ventilator-associated pneumonia on the Canadian health care system. J Crit Care. 2008 Mar;23(1):5-10. doi: 10.1016/j.jcrc.2007.11.012.

    PubMed 18359415
  • Van Saene H., Peric M., De La Cal M., Silvestri L.: Pneumonia during Mechanical Ventilation. Anestiologie a Intenzivni Medicina 2004; 15: 89-100.

  • Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002 Apr 1;165(7):867-903. doi: 10.1164/ajrccm.165.7.2105078.

    PubMed 11934711
  • Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med. 2006 Dec 21;355(25):2619-30. doi: 10.1056/NEJMoa052904.

    PubMed 17182987
  • Heyland DK, Dodek P, Muscedere J, Day A, Cook D; Canadian Critical Care Trials Group. Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia. Crit Care Med. 2008 Mar;36(3):737-44. doi: 10.1097/01.CCM.0B013E31816203D6.

    PubMed 18091545
  • Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D; VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: prevention. J Crit Care. 2008 Mar;23(1):126-37. doi: 10.1016/j.jcrc.2007.11.014.

    PubMed 18359430
  • Muscedere J, Dodek P, Keenan S, Fowler R, Cook D, Heyland D; VAP Guidelines Committee and the Canadian Critical Care Trials Group. Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: diagnosis and treatment. J Crit Care. 2008 Mar;23(1):138-47. doi: 10.1016/j.jcrc.2007.12.008.

    PubMed 18359431
  • Muscedere JG, McColl C, Shorr A, Jiang X, Marshall J, Heyland DK; Canadian Critical Care Trials Group. Determinants of outcome in patients with a clinical suspicion of ventilator-associated pneumonia. J Crit Care. 2008 Mar;23(1):41-9. doi: 10.1016/j.jcrc.2007.12.007.

    PubMed 18359420
  • Rello J, Esandi ME, Diaz E, Mariscal D, Gallego M, Valles J. The role of Candida sp isolated from bronchoscopic samples in nonneutropenic patients. Chest. 1998 Jul;114(1):146-9. doi: 10.1378/chest.114.1.146.

    PubMed 9674461
  • el-Ebiary M, Torres A, Fabregas N, de la Bellacasa JP, Gonzalez J, Ramirez J, del Bano D, Hernandez C, Jimenez de Anta MT. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. An immediate postmortem histologic study. Am J Respir Crit Care Med. 1997 Aug;156(2 Pt 1):583-90. doi: 10.1164/ajrccm.156.2.9612023.

    PubMed 9279244
  • Senn L, Robinson JO, Schmidt S, Knaup M, Asahi N, Satomura S, Matsuura S, Duvoisin B, Bille J, Calandra T, Marchetti O. 1,3-Beta-D-glucan antigenemia for early diagnosis of invasive fungal infections in neutropenic patients with acute leukemia. Clin Infect Dis. 2008 Mar 15;46(6):878-85. doi: 10.1086/527382.

    PubMed 18260755
  • Odabasi Z, Mattiuzzi G, Estey E, Kantarjian H, Saeki F, Ridge RJ, Ketchum PA, Finkelman MA, Rex JH, Ostrosky-Zeichner L. Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis. 2004 Jul 15;39(2):199-205. doi: 10.1086/421944. Epub 2004 Jun 28.

    PubMed 15307029
  • Wheeler RT, Fink GR. A drug-sensitive genetic network masks fungi from the immune system. PLoS Pathog. 2006 Apr;2(4):e35. doi: 10.1371/journal.ppat.0020035. Epub 2006 Apr 28.

    PubMed 16652171
  • Azoulay E, Timsit JF, Tafflet M, de Lassence A, Darmon M, Zahar JR, Adrie C, Garrouste-Orgeas M, Cohen Y, Mourvillier B, Schlemmer B; Outcomerea Study Group. Candida colonization of the respiratory tract and subsequent pseudomonas ventilator-associated pneumonia. Chest. 2006 Jan;129(1):110-7. doi: 10.1378/chest.129.1.110.

    PubMed 16424420

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Normal Saline and anidulafungin in people with Ventilator Associated Pneumonia and Respiratory Tract Infection, run by Daren K. Heyland at 6 sites in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 1 Feb 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 1 Feb 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Overall Recruitment Rate (time frame: 32 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00934934, which also lists 33 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Feb 2021.

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