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Necrotizing Soft Tissue InfectionNCT06002607

Shorter Versus Extended Course of Antibiotic Therapy for Necrotizing Soft Tissue Infections

An observational study of Necrotizing Soft Tissue Infection, run by University of California, Irvine at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Necrotizing soft tissue infection (NSTI) is a devastating disease that results in a high rate of in-hospital complications and despite advances in critical care, wound care, and early intervention, NSTI continues to be associated with a mortality rate of nearly 30%. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Necrotizing Soft Tissue Infection
What is being tested?
Antibiotic duration (short course) and Antibiotic duration (extended course)
How many people
50 participants
Where
1 siteUnited States
Study dates
28 Dec 2023to 1 Dec 2026
Phase
Observational
Are there results?
Not yet: the study is under way

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: Adult patients with a diagnosis of Necortizing Soft Tissue Infection who undergo consultation by the Emergency General Surgery service.

Who may be able to join

  • Adult patients 18 years of age or older with all following criteria:
  • Presenting to the Emergency Department with history, exam and/or imaging concerning NSTI, AND
  • Patients who undergo consultation by the Emergency General Surgery service, AND
  • Patients included must have skin or soft tissue findings consistent with NSTI (erythema, crepitus, or pain out of proportion to exam), AND
  • Systemic signs of infection including fever (temperature >38.0°C) or leukocytosis (≥11,000 peripheral white cells per cubic millimeter), AND
  • Patients who undergo excisional debridement and/or amputation to achieve source control.

Who cannot join

  • Pregnant patients
  • Prisoners
  • Patients with bacteremia upon admission
  • Patients unable to provide consent (including no legally authorized representative)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Areg Grigorian, MD contact

8184389093

agrigori@hs.uci.edu

Jeffry Nahmias, MD contact

9493073035

jnahmias@hs.uci.edu

United States1 site, 1 recruiting
  • University of California Irvine Medical Center

    Orange, California, 92868

    Areg Grigorian, MD, 8184389093, agrigori@hs.uci.edu

    Jeffry Nahmias, MD, 9493073035, jnahmias@hs.uci.edu

    Recruiting

Other trials in United States

About this study

Official title: Pilot Randomized Controlled Trial of Shorter Versus Extended Course of Antibiotic Therapy for Necrotizing Soft Tissue Infections

Necrotizing soft tissue infection (NSTI) is a devastating disease that results in a high rate of in-hospital complications and despite advances in critical care, wound care, and early intervention, NSTI continues to be associated with a mortality rate of nearly 30%. The antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. Although one of the tenets of management for NSTI is early broad-spectrum intravenous antibiotics (listed above), the duration of antibiotics needed is not well defined. Currently, there exists wide variation in the duration of antibiotics for NSTI ranging between 2-16 days. The objective of this study is to evaluate the safety of a shorter course of antibiotics hypothesizing that a short duration of antibiotics for 48-hours after source-control is achieved will have similar risk of morbidity and mortality compared to a 7-day course of antibiotics post source control. A second aim of this study will be to identify if serum procalcitonin levels/ratio correspond to resolution of systemic infection in patients with NSTI.

Read the detailed description

The objective of this study is to evaluate the safety of a shorter course of antibiotics hypothesizing that a short duration of antibiotics for 48-hours after source-control is achieved will have similar risk of morbidity and mortality compared to a 7-day course of antibiotics post source control. The proposed shortened duration is considered within standard of care as the IDSA suggests 48-72 hours of antibiotics after source control, however this was due mostly to expert opinion until a recent single-center study using historical controls demonstrated a 48-hour duration of antibiotics to be safe. A second aim of this study will be to identify if serum procalcitonin levels/ratio correspond to resolution of systemic infection in patients with NSTI. This pilot study may help limit use of antibiotics which are associated with both cost and significant adverse events including antimicrobial resistance and clostridium difficile infections. In addition, the data would support grant submission of a larger, multi-center study with sufficient power to demonstrate the safety profile and potential benefits of a shorter duration of antibiotics, which has been shown to be beneficial in previous large surgical infection studies.

Specific Aims:

Aim#1: Establish the safety of an abbreviated course (48 hours after source control) compared to a prolonged (7 days after source control) course of antibiotics in terms of in-hospital mortality.

Aim#2: Compare the incidence of hospital length of stay and in-hospital complications including unplanned return to the operating room, ventilator days, and antibiotic associated complications (e.g., clostridium difficile infection) in the two comparison groups: abbreviated (48-hours) and prolonged antibiotics (7-days) after source control.

Aim#3: Identify a critical threshold of biochemical procalcitonin or a % decrease in procalcitonin from the initial procalcitonin obtained upon admission that suggests resolution of systemic infection in patients with NSTI. This will be done by obtaining a serum procalcitonin upon admission and daily for up to 7 days from admission or once source control has been achieved.

Being tested
Antibiotic duration (short course), Antibiotic duration (extended course)

What participants receive

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

  • Antibiotic duration (short course)Other

    The patient will be enrolled in a 48-hour course of antibiotics.

  • Antibiotic duration (extended course)Other

    The patient will be enrolled in a 7 day course of antibiotics.

Study groups in NCT06002607
Study groupRoleWhat they receive
Short course of antibioticsPatients assigned to a 48-hour course of antibiotics. As the current standard of care, the antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin-Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. The specific choice of antibiotic therapy will not be dictated by the study protocol but by the attending surgeon taking care of the patient
Receives: Other: Antibiotic duration (short course)
Long course of antibioticsPatients assigned to a 7 day course of antibiotics. As the current standard of care, the antibiotics used in this treatment are Clindamycin, Vancomycin, Piperacillin-Tazobactam; these antibiotics may be administered combined or individually, based on individualized patient treatment. The specific choice of antibiotic therapy will not be dictated by the study protocol but by the attending surgeon taking care of the patient
Receives: Other: Antibiotic duration (extended course)

What is being measured

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

  1. Safety of the antibiotic course duration

    In-hospital complications

    Measured: Through study completion, an average of 1 year

  2. Mortality rate

    In-hospital mortality

    Measured: Through study completion, an average of 1 year

Secondary outcomes (21)
  1. Age

    Age in years

    Measured: Baseline, pre-intervention/procedure/surgery

  2. Sex

    Sex (male/female)

    Measured: Baseline, pre-intervention/procedure/surgery

  3. BMI (body mass index)

    Body mass index (weight and height will be combined to report BMI in kg/m^2)

    Measured: Baseline, pre-intervention/procedure/surgery

  4. Blood Pressure

    Blood Pressure (mmHg)

    Measured: Baseline, pre-intervention/procedure/surgery

  5. Heart Rate

    Heart rate (beats/minute)

    Measured: Baseline, pre-intervention/procedure/surgery

  6. Respiratory rate

    Respiratory rate (breaths/minute)

    Measured: Baseline, pre-intervention/procedure/surgery

  7. Temperature

    Temperature (Fahrenheit)

    Measured: Baseline, pre-intervention/procedure/surgery

  8. Comorbidities

    Comorbidities (e.g., diabetes, hypertension, cirrhosis, chronic kidney disease, etc.)

    Measured: Baseline, pre-intervention/procedure/surgery

  9. Transfusion requirements

    Number of Packed Red Blood Cells transfused measured in milliliters

    Measured: Baseline, pre-intervention/procedure/surgery

  10. NSTI location

    Anatomical location of soft tissue infection

    Measured: Baseline, pre-intervention/procedure/surgery

  11. Operations

    Number of surgical procedures

    Measured: Through study completion, an average of 1 year

  12. Serum concentration of procalcitonin

    Procalcitonin ng/mL

    Measured: Upon admission and daily blood sample for 7 days

  13. Serum concentration of white blood cell

    White blood cell count cells per microliter (cells/μL)

    Measured: Through study completion, an average of 1 year

  14. Serum concentration of hemoglobin

    Hemoglobin grams/deciliter

    Measured: Through study completion, an average of 1 year

  15. Serum concentration of sodium

    Sodium millimoles per liter (mmol/L)

    Measured: Through study completion, an average of 1 year

  16. Serum concentration of C-reactive protein

    C-reactive protein milligrams/liter

    Measured: Through study completion, an average of 1 year

  17. Serum concentration of glucose

    Glucose milligrams/deciliter

    Measured: Through study completion, an average of 1 year

  18. Serum concentration of creatinine

    Creatinine milligram/deciliter

    Measured: Through study completion, an average of 1 year

  19. Total hospital length of stay

    Total days of hospital stay

    Measured: Through study completion, an average of 1 year

  20. Total intensive care unit (ICU)

    Total days of ICU stay

    Measured: Through study completion, an average of 1 year

  21. Total ventilator days

    Total days of ventilation support for the patient

    Measured: Through study completion, an average of 1 year

Timeline

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

  1. First posted21 Aug 2023
  2. Study start28 Dec 2023
  3. Primary completion1 Dec 2026 (estimated)
  4. Study completion1 Dec 2026 (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
Case-control
Time perspective
Prospective
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06002607
Sponsor's protocol ID
2826
Status last verified
Feb 2026
First submitted
11 Jul 2023
Last updated
10 Feb 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: The overall study results will be listed on Clinicaltrials.gov

Publications

  • Yilmazlar T, Ozturk E, Alsoy A, Ozguc H. Necrotizing soft tissue infections: APACHE II score, dissemination, and survival. World J Surg. 2007 Sep;31(9):1858-1862. doi: 10.1007/s00268-007-9132-1.

    PubMed 17610007
  • Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, Hendricks DL, Hardesty RA. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. Am Surg. 2002 Feb;68(2):109-16.

    PubMed 11842952
  • Hefny AF, Eid HO, Al-Hussona M, Idris KM, Abu-Zidan FM. Necrotizing fasciitis: a challenging diagnosis. Eur J Emerg Med. 2007 Feb;14(1):50-2. doi: 10.1097/01.mej.0000228447.48276.7b.

    PubMed 17198329
  • Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52. doi: 10.1093/cid/ciu444.

    PubMed 24973422
  • Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011 Sep 22;9:107. doi: 10.1186/1741-7015-9-107.

    PubMed 21936959
  • Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004 Apr;89(4):1512-25. doi: 10.1210/jc.2002-021444. No abstract available.

    PubMed 15070906
  • Faraklas I, Yang D, Eggerstedt M, Zhai Y, Liebel P, Graves G, Dissanaike S, Mosier M, Cochran A. A Multi-Center Review of Care Patterns and Outcomes in Necrotizing Soft Tissue Infections. Surg Infect (Larchmt). 2016 Dec;17(6):773-778. doi: 10.1089/sur.2015.238. Epub 2016 Nov 11.

    PubMed 27834617
  • Terzian WTH, Nunn AM, Call EB, Bliss SE, Swinarska JT, Rigdon J, Avery MD, Hoth JJ, Miller PR 3rd. Duration of Antibiotic Therapy in Necrotizing Soft Tissue Infections: Shorter is Safe. Surg Infect (Larchmt). 2022 Jun;23(5):430-435. doi: 10.1089/sur.2022.011. Epub 2022 Apr 22.

    PubMed 35451883
  • May AK, Talisa VB, Wilfret DA, Bulger E, Dankner W, Bernard A, Yende S. Estimating the Impact of Necrotizing Soft Tissue Infections in the United States: Incidence and Re-Admissions. Surg Infect (Larchmt). 2021 Jun;22(5):509-515. doi: 10.1089/sur.2020.099. Epub 2020 Aug 21.

    PubMed 32833599

Questions about this trial

What is this clinical trial studying?

An observational study of Necrotizing Soft Tissue Infection, run by University of California, Irvine at 1 site in United States.

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 6 inclusion and 4 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: looking for participants now, as of the sponsor's last update on 10 Feb 2026. 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 United States. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Areg Grigorian, MD (8184389093, agrigori@hs.uci.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Safety of the antibiotic course duration (time frame: Through study completion, an average of 1 year). 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 NCT06002607, which also lists 9 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 Feb 2026.

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