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VRE InfectionAEGONNCT04624464

Assessing the Impact of Antimicrobial Exposure and Infection Control Measures on the Spread of VRE

An observational study of VRE Infection and Antibiotic Resistant Infection, run by University Hospital of Cologne at 1 site in Germany.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The AEGON study is a German multicenter, prospective observational study. The study consists of two parts, which are carried out at all participating study sites and include two different patient cohorts. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
VRE Infection, Antibiotic Resistant Infection
What is being tested?
Rectal swabs - microbiological analysis and Examination of patient room
How many people
170 participants
Where
1 siteGermany
Study dates
1 Jan 2019to 31 Dec 2020
How long will I take part?
10 Weeks
Phase
Observational
Are there results?
None posted in the registry

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

Study population: The selection of patients to be included in Part 1 of the AEGON study is based on the risk stratification for the nosocomial acquisition of VREf performed in the CONTROL study. It is planned to include a total of 150 patients from the participating study centers in Part 1. Based on the results of the CONTROL study, it can be assumed that within the selected target group in approx. 11% there is already an VREf colonisation by direct culture at admission and in 15% of the cases (22 of 150 patients) a nosocomial acquisition of VREf by direct culture (see method part) can be determined. Patients with VREcolonization detected at admission are excluded from the study.

Who may be able to join

  • ≥ 18 years
  • Patients with malignant primary disease and current inpatient admission to a normal ward with expected inpatient stay of at least 15 days
  • High risk of exposure to antibiotics during the stay
  • Written informed consent of the patient after clarification has been given

Who cannot join

  • Already known current or documented past colonisation or infection by VRE
  • Simultaneous participation in other studies is only an exclusion criterion if the other study explicitly excludes participation in observational studies or if the other study complicates the interpretation of the endpoints of AEGON (e.g. double-blind study on antibiotic use).

Trial locations and contacts

1 site in 1 country.

Annika Y. Claßen, Dr. med contact

+49221 47897345

annika.classen@uk-koeln.de

Lena M. Biehl, Dr. med contact

+49221 4781425649

lena.biehl@uk-koeln.de

Germany1 site, 1 recruiting
  • University Hospital of Cologne

    Cologne, North Rhine-Westphalia, 50931

    Jörg Janne Vehreschild, MD, joerg.vehreschild@uk-koeln.de

    Recruiting

Other trials in Germany

About this study

Official title: Assessing the Impact of Antimicrobial Exposure and Infection Control Measures on the Spread of Vancomycin-resistant Enterococcus Faecium (VREf) - A Prospective Study

The AEGON study is a German multicenter, prospective observational study. The study consists of two parts, which are carried out at all participating study sites and include two different patient cohorts. Part 1 focuses on the collection and analysis of rectal swabs from newly admitted VREf-negative patients at high risk of nosocomial VREf acquisition. Moreover, patients included into this part of the study will undergo in-depth documentation of clinical data if an antibiotic therapy is administered. Initiated antibiotic therapies will then be assessed by an AMS board (Antimicrobial Stewardship Board). In Part 2, environmental investigations will be performed in newly occupied single rooms of previously known VREf-positive patients. In addition, rectal swabs will be collected and data on antibiotic exposure of these patients will be documented in order to correlate the VRE contamination burden of surfaces with the intestinal VREf-load and antibiotic exposure.

Read the detailed description

Current studies show that Vancomycin-resistant Enterococci (VRE) have become increasingly widespread throughout Germany in recent years, especially E. faecium (VREf). Healthy individuals can come into contact with VREf in various ways, for example via the food chain, contaminated drinking water or animal contacts. A possibly caused low-grade colonisation of the gastrointestinal tract with VREf (so-called low-level colonisation) can remain undetected during hospital admission using routine screening methods. The AEGON study, based on the use of state-of-the-art molecular diagnostics and comprehensive clinical data collection, will provide a detailed analysis of the factors involved in the rapid spread of VREf. In addition, diagnostic detection limits of common screening methods are determined by the use of additional diagnostics such as enrichment culture or molecular VREf detection.

The study is a German multicenter, prospective observational study and consists of two parts, which are carried out at all participating study sites and include two different patient cohorts. Part 1 focuses on the collection and analysis of rectal swabs from newly admitted VRE-negative patients at high risk of nosocomial VREf acquisition. Moreover, patients included into this part of the study will undergo in-depth documentation of clinical data if an antibiotic therapy is administered. Initiated antibiotic therapies will then be assessed by an AMS board. In Part 2, environmental investigations will be performed in newly occupied single rooms of previously known VREf-positive patients. In addition, rectal swabs will be collected and data on antibiotic exposure of these patients will be documented in order to correlate the VRE contamination burden of surfaces with the intestinal VREf-load and antibiotic exposure. The AEGON study, based on the use of state-of-the-art molecular diagnostics and comprehensive clinical data collection, will provide a detailed analysis of the factors involved in the rapid spread of VREf. In addition, diagnostic detection limits of common screening methods are determined by the use of additional diagnostics such as enrichment culture or molecular VREf detection.

Being tested
Rectal swabs - microbiological analysis, Examination of patient room
Keywords
VRE, Infection Control Measures, Antimicrobial Stewardship

What participants receive

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

  • Rectal swabs - microbiological analysisOther

    Microbial analyses will be performed from the rectal swabs obtained.

  • Examination of patient roomOther

    Only performed for cohort 2

Study groups in NCT04624464
Study groupRoleWhat they receive
Cohort 1: VRE negative at admission150 patients meeting the following inclusion criteria: * ≥ 18 years * Patients with malignant primary disease and current inpatient admission to a normal ward with expected inpatient stay of at least 15 days * High risk of exposure to antibiotics during the stay * Written informed consent of the patient after clarification has been given Exclusion criteria: * Already known current or documented past colonisation or infection by VRE * Simultaneous participation in other studies is only an exclusion criterion if the other study explicitly excludes participation in observational studies or if the other study complicates the interpretation of the endpoints of AEGON (e.g. double-blind study on antibiotic use).
Receives: Other: Rectal swabs - microbiological analysis
Cohort 2: VRE positive at admissionA total 20 known VREf-positive patients meeting the following inclusion criteria: * Intestinal VREf colonization already known at the time of admission (e.g. based on examinations during previous stays or in external facilities) * Accommodation in a single room or alternatively multi-bed room with single occupancy on standard wards * Expected stay of at least 7 days
Receives: Other: Rectal swabs - microbiological analysis; Other: Examination of patient room

What is being measured

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

  1. VREf - Intestinal microbiota

    Primary Outcome for Cohort 1: Rate of VREf intestinal colonization detected by enrichment culture or specific PCR at time of uptake not detected by standard culture methods

    Measured: Baseline

  2. VREf - Patient rooms

    Primary Outcome for Cohort 2: Description of the spread of VREf in single rooms newly enrolled in known VREf-positive patients

    Measured: Change from baseline spread to spread at 10 weeks.

Secondary outcomes (10)
  1. Standard culture VREf detection

    Cohort 1: Quantitative detection limit of standard culture methods for VREf detection compared to enrichment culture and qPCR (quantitative polymerase chain reaction)

    Measured: baseline and every week up to 10 weeks max.

  2. Antibiotics

    Cohort 1: Identification of antibiotic classes that increase the risk of clonal expansion and subsequent domination by VREf. Domination by VREf is defined as the combination of cultural VREf detection from a sample and 16S rRNA (16S ribosomal ribonucleic acid) sequencing of the relative frequency of the Enterococcus genus over 30% as the most abundant genus in the sample.

    Measured: baseline and every week up to 10 weeks max.

  3. Inadequately administered antibiotics

    Cohort 1: Proportion of inadequately administered antibiotics, defined as unnecessary, too long, too broad or too high doses in patients who develop VREf domination (see definition above) compared to patients without VREf acquisition and patients with VREf acquisition but without domination.

    Measured: baseline and every week up to 10 weeks max.

  4. Adequate antibiotic

    Cohort 1: Rate of patients with no or adequate antibiotic therapy compared to patients with inadequate antibiotic therapy who develop a new colonization with VREf during the stay

    Measured: baseline and every week up to 10 weeks max.

  5. Influence of antibiotic exposure duration

    Cohort 1: Influence of antibiotic exposure duration on microbiota

    Measured: baseline and every week up to 10 weeks max.

  6. Influence of antibiotic class

    Cohort 1: Influence of antibiotic class on microbiota

    Measured: baseline and every week up to 10 weeks max.

  7. VREf contamination

    Cohort 2: Identification of high risk objects and surfaces for VREf contamination in patient rooms with known VREf-positive patients

    Measured: baseline at least every 72 hours up to max of 20 days.

  8. Correlation of the antibiotic exposure

    Cohort 2: Correlation of the antibiotic exposure of already known VREf-positive patients with the contamination load of objects and surfaces in the corresponding patient room.

    Measured: baseline at least every 72 hours up to max of 20 days.

  9. Contamination load of objects

    Cohort 2: Correlation of the relative proportion of enterococci in intestinal microbiota with the contamination load of objects and surfaces in the associated patient room

    Measured: baseline at least every 72 hours up to max of 20 days.

  10. Cleaning quality

    Cohort 2: Correlation of cleaning quality with the contamination load of VREf on objects and surfaces in rooms of known VRE-positive patients

    Measured: baseline at least every 72 hours up to max of 20 days.

Timeline

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

  1. First posted10 Nov 2020
  2. Study start1 Jan 2019
  3. Primary completion31 Dec 2020 (estimated)
  4. Study completion31 Dec 2020 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
170 participants (estimated)
Target duration
10 Weeks
IDs, dates and publications
ClinicalTrials.gov ID
NCT04624464
Sponsor's protocol ID
19-1325
Acronym
AEGON
Status last verified
Nov 2020
First submitted
30 Jul 2020
Last updated
10 Nov 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Gastmeier P, Schroder C, Behnke M, Meyer E, Geffers C. Dramatic increase in vancomycin-resistant enterococci in Germany. J Antimicrob Chemother. 2014 Jun;69(6):1660-4. doi: 10.1093/jac/dku035. Epub 2014 Mar 9.

    PubMed 24615816
  • Liss BJ, Vehreschild JJ, Cornely OA, Hallek M, Fatkenheuer G, Wisplinghoff H, Seifert H, Vehreschild MJ. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection. 2012 Dec;40(6):613-9. doi: 10.1007/s15010-012-0269-y. Epub 2012 Jun 5.

    PubMed 22665143
  • Vehreschild MJGT, Haverkamp M, Biehl LM, Lemmen S, Fatkenheuer G. Vancomycin-resistant enterococci (VRE): a reason to isolate? Infection. 2019 Feb;47(1):7-11. doi: 10.1007/s15010-018-1202-9. Epub 2018 Sep 3.

    PubMed 30178076
  • Biehl LM, Higgins P, Wille T, Peter K, Hamprecht A, Peter S, Dorfel D, Vogel W, Hafner H, Lemmen S, Panse J, Rohde H, Klupp EM, Schafhausen P, Imirzalioglu C, Falgenhauer L, Salmanton-Garcia J, Stecher M, Vehreschild JJ, Seifert H, Vehreschild MJGT. Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards. Clin Microbiol Infect. 2019 Aug;25(8):1013-1020. doi: 10.1016/j.cmi.2018.12.029. Epub 2019 Jan 12.

    PubMed 30641228

Questions about this trial

What is this clinical trial studying?

An observational study of VRE Infection and Antibiotic Resistant Infection, run by University Hospital of Cologne at 1 site in Germany.

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 4 inclusion and 2 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: status not confirmed, as of the sponsor's last update on 10 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

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

Contact Annika Y. Claßen, Dr. med (+49221 47897345, annika.classen@uk-koeln.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

VREf - Intestinal microbiota (time frame: Baseline). The study lists 2 primary outcomes in all. 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 NCT04624464, which also lists 4 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 10 Nov 2020.

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