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CirrhosisNCT06634940

International Surveillance of Antimicrobial Resistance in Cirrhosis-Related Infections

An observational study of Cirrhosis and Bacterial Infections, run by Hospital Italiano de Buenos Aires at 1 site in Argentina.

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

What is this study about? This study tracks antibiotic resistance in patients with cirrhosis who develop bacterial infections. Cirrhosis is a condition where the liver is severely scarred, and people with cirrhosis are at high risk for serious bacterial infections. Read more about this study

Who is it for?
Ages 17 years and older
How many people
1,000 participants
Where
1 siteArgentina
Study dates
15 Nov 2020to 1 Jun 2031
How long will I take part?
1 Week
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 17 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: Hospitalized patients in Latin American countries

Who may be able to join

  • Episodes of culture-confirmed bacterial infections
  • Patients diagnosed with cirrhosis
  • Infections diagnosed either at the time of hospital admission or during hospitalization

Who cannot join

  • History of solid organ or hematopoietic stem cell transplantation
  • Declined to participate in the study

Trial locations and contacts

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

Sebastián M Marciano, Principal Investigator. contact

54 11 49590200 ext. 5370

sebastian.marciano@hospitalitaliano.org.ar

Gonzalo Gomez Perdiguero, Registry coordinator contact

54 11 49590200 ext. 5370

gonzalo.gomez@hospitalitaliano.org.ar,

Argentina1 site, 1 recruiting
  • Hospital Italiano de Buenos Aires

    Buenos Aires, Buenos Aires F.D., C1199ABB.

    Sebastián Marciano, Principal Investigator, MD, 54 11 49590200 ext. 5370, sebastian.marciano@hospitalitaliano.org.ar

    Gonzalo Gomez Perdiguero, Subinvestigator, MD, 54 11 49590200 ext. 5370, gonzalo.gomez@hospitalitaliano.org.ar

    Recruiting

Other trials in Argentina

About this study

What is this study about?

This study tracks antibiotic resistance in patients with cirrhosis who develop bacterial infections. Cirrhosis is a condition where the liver is severely scarred, and people with cirrhosis are at high risk for serious bacterial infections.

Read more

Why is this study important?

Bacterial infections are common in patients with cirrhosis, affecting 25-46% of those who are hospitalized. These infections can be life-threatening, with 1 in 4 patients dying from complications. Many of these infections are becoming harder to treat because the bacteria are resistant to antibiotics. Infections caused by resistant bacteria are increasing, which makes finding the right antibiotic quickly even more difficult.

In other regions of the world, guidelines exist to help doctors choose the right antibiotics for cirrhosis patients. However, in Latin America, we don't have specific guidelines for our region, and doctors currently rely on recommendations from the U.S. or Europe. These guidelines may not reflect the local patterns of bacterial infections and resistance we see here.

What is the goal of this study?

The main goal of this study is to create a long-term system to track how bacteria respond to antibiotics in patients with cirrhosis in Latin America. By collecting data from hospitals across different countries, we aim to:

  • Identify how many infections are caused by multidrug-resistant bacteria.
  • Understand how antibiotics (such as ceftriaxone, vancomycin, and carbapenems) act against these infections.
  • Generate reports informing bacterial resistance patterns to help doctors make better patient treatment decisions.

What do we hope to achieve?

We hope the data we collect will help develop guidelines for patients with cirrhosis in Latin America. These guidelines will ensure that doctors use the most effective antibiotics based on real-time data from our region. This should improve patient outcomes and help prevent the spread of resistant bacteria.

Read the detailed description

Bacterial infections are among the most common complications in patients with cirrhosis, affecting 25-46% of those hospitalized. In two-thirds of cases, these infections are diagnosed during hospitalization, while the remainder develop during the hospital stay. The high mortality rate associated with these infections is significant, with one in four patients succumbing to the complication.

Regarding origin, 30-35% of bacterial infections in patients with cirrhosis are classified as spontaneous, with the rest being non-spontaneous. Spontaneous bacterial peritonitis is the most frequently reported infection specific to patients with cirrhosis and portal hypertension. Other spontaneous infections include spontaneous bacteremia and spontaneous bacterial empyema.

A significant factor influencing patient outcomes in bacterial infections is the rapid initiation of appropriate empirical antibiotic therapy. It is generally recommended that empirical treatment covers 80% of expected bacteria in stable patients and 90% in critically ill patients. However, this goal is increasingly challenging due to shifting epidemiology, with a rise in Gram-positive organisms and a growing incidence of multidrug resistance. Recent studies have shown that 34% of infections in patients with cirrhosis are caused by multidrug-resistant microorganisms, which are linked to poorer outcomes, complicating patient management, and increasing healthcare costs.

Although guidelines for empirical antibiotic treatment exist in other regions, none have been developed for Latin America. As a result, clinicians often rely on recommendations from the United States or Europe, which may not accurately reflect the epidemiology in this region.

GENERAL OBJECTIVES

  1. To establish and sustain a surveillance system to monitor the antibiotic susceptibility patterns of microorganisms responsible for infections in patients with cirrhosis.
  2. To produce periodic reports on evolving resistance patterns of microorganisms involved in infections in patients with cirrhosis.

EXPECTED OUTCOMES

This project aligns with global strategies to address the rise in infections caused by multidrug-resistant microorganisms. By applying a research methodology based on international standards, the study aims to ensure the collection of high-quality data that can lead to actionable outcomes.

Our research team initiated this project in 2020 to create a continuous surveillance program for bacterial infections in cirrhosis patients within our region. The goal is to collect and share real-time data on antibiotic susceptibility patterns.

We expect to generate results that will enable the production of detailed reports on the susceptibility patterns of bacterial infections in patients with cirrhosis at different levels. This will provide the necessary information to develop region-specific guidelines for the appropriate use of empirical antibiotics in this population. Additionally, periodic updates will reflect ongoing epidemiological changes.

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Keywords
antibiotics, empirical treatment, methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing organisms, Carbapenemase-Producing Enterobacteriaceae, de-escalation, guidelines, empiric antibiotics
Medical subject headings
Fibrosis, Bacterial Infections

What is being measured

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

  1. Proportion of multidrug-resistant organisms

    Estimated by using the total number of bacterial infection episodes involving at least one multidrug-resistant organism as the numerator and the total number of bacterial infection episodes as the denominator.

    Measured: 1 week

  2. Proportion of extensively drug-resistant microorganisms

    Estimated by using the total number of bacterial infection episodes involving at least one extensively drug-resistant microorganism as the numerator and the total number of bacterial infection episodes as the denominator.

    Measured: 1 week

  3. Proportion of pan drug-resistant microorganisms

    Estimated by using the total number of bacterial infection episodes involving at least one pan drug-resistant microorganism as the numerator and the total number of bacterial infection episodes as the denominator.

    Measured: 1 week

Secondary outcomes (20)
  1. Proportion of episodes on infection susceptible to quinolones

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to quinolones as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to quinolones for the episode to be considered susceptible.

    Measured: 1 week

  2. Proportion of episodes of infection susceptible to nitrofurantoin

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to nitrofurantoin as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to nitrofurantoin for the episode to be considered susceptible.

    Measured: 1 week

  3. Proportion of episodes of infection susceptible to Trimethoprim-Sulfamethoxazole

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to Trimethoprim-Sulfamethoxazole as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to Trimethoprim-Sulfamethoxazole for the episode to be considered susceptible.

    Measured: 1 week

  4. Proportion of episodes of infection susceptible to ceftriaxone

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to ceftriaxone as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to ceftriaxone for the episode to be considered susceptible.

    Measured: 1 week

  5. Proportion of episodes of infection susceptible to ceftazidime

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to ceftazidime as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to ceftazidime for the episode to be considered susceptible.

    Measured: 1 week

  6. Proportion of episodes of infection susceptible to cefepime

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to cefepime as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to cefepime for the episode to be considered susceptible

    Measured: 1 week

  7. Proportion of episodes of infection susceptible to aminoglycosides

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to aminoglycosides as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to aminoglycosides for the episode to be considered susceptible

    Measured: 1 week

  8. Proportion of episodes of infection susceptible to piperacillin-tazobactam

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to piperacillin-tazobactam as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to piperacillin-tazobactam for the episode to be considered susceptible

    Measured: 1 week

  9. Proportion of episodes of infection susceptible to ertapenem

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to ertapenem as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to ertapenem for the episode to be considered susceptible

    Measured: 1 week

  10. Proportion of episodes of infection susceptible to meropenem/imipenem

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to meropenem or imipenem as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to meropenem or imipenem for the episode to be considered susceptible

    Measured: 1 week

  11. Proportion of episodes of infection susceptible to colistin:

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to colistin as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to colistin for the episode to be considered susceptible

    Measured: 1 week

  12. Proportion of episodes of infection susceptible to ceftazidime-avibactam

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to ceftazidime-avibactam as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to ceftazidime-avibactam for the episode to be considered susceptible

    Measured: 1 week

  13. Proportion of episodes of infection susceptible to ceftolozane-tazobactam

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to ceftolozane-tazobactam as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to ceftolozane-tazobactam for the episode to be considered susceptible

    Measured: 1 week

  14. Proportion of episodes of infection susceptible to piperacillin-tazobactam plus vancomycin

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to piperacillin-tazobactam or vancomycin as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible.

    Measured: 1 week

  15. Proportion of episodes of infection susceptible to carbapenem plus vancomycin

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to both carbapenem and vancomycin as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to both antibiotics for the episode to be considered susceptible

    Measured: 1 week

  16. Proportion of episodes of infection susceptible to carbapenem plus linezolid

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to carbapenems or linezolid as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible.

    Measured: 1 week

  17. Proportion of episodes of infection susceptible to carbapenem + linezolid

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to either carbapenem or linezolid as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible.

    Measured: 1 week

  18. Proportion of episodes of infection susceptible to aminoglycoside + colistin

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to either aminoglycoside or colistin as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible.

    Measured: 1 week

  19. Proportion of episodes of infection susceptible to ceftazidime-avibactam + aztreonam

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to either ceftazidime-avibactam or aztreonam as the numerator and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible.

    Measured: 1 week

  20. Proportion of episodes of infection susceptible to ceftazidime-avibactam + vancomycin

    Estimated by using the total number of bacterial infection episodes involving microorganisms with in vitro susceptibility to either ceftazidime-avibactam or vancomycin as the numerator, and the total number of bacterial infection episodes as the denominator. For episodes involving more than one organism, all organisms must be susceptible to at least one of the antibiotics for the episode to be considered susceptible

    Measured: 1 week

Timeline

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

  1. First posted10 Oct 2024
  2. Study start15 Nov 2020
  3. Primary completion1 Dec 2030 (estimated)
  4. Study completion1 Jun 2031 (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 only
Time perspective
Cross-sectional
Enrolment
1,000 participants (estimated)
Target duration
1 Week
IDs, dates and publications
ClinicalTrials.gov ID
NCT06634940
Sponsor's protocol ID
5821
Status last verified
Oct 2024
First submitted
6 Oct 2024
Last updated
10 Oct 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: I am willing to share individual participant data based on the proposal, the project's relevance and importance, and ensuring data security

Questions about this trial

What is this clinical trial studying?

An observational study of Cirrhosis and Bacterial Infections, run by Hospital Italiano de Buenos Aires at 1 site in Argentina.

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 3 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: looking for participants now, as of the sponsor's last update on 10 Oct 2024. 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 Argentina. 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 Sebastián M Marciano, Principal Investigator. (54 11 49590200 ext. 5370, sebastian.marciano@hospitalitaliano.org.ar), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of multidrug-resistant organisms (time frame: 1 week). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 Oct 2024.

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