The AOT (Acridine Orange and Taurolidine) Trial
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Purpose
Total parenteral (intravenous) nutrition in the home setting (Home TPN or HPN) is a life saving strategy in patients who suffer from severe intestinal failure. Unfortunately, this treatment modality remains complicated by the development of frequent infectious complications. This especially relates to the device that is used to establish venous access, mostly a catheter (Hickman-Broviac type) or a port-a-cath.
Taurolodine is an antimicrobial agent without any known side effects or resistance-related problems that holds promise as an effective antibiotic lock solution to prevent catheter infections, as demonstrated recently in a pilot study in HPN patients [Jurewitsch, 2005].
In addition, recently a test has been described which may enable to confirm a suspected diagnosis of central line infection within one hour, the so-called Acridine Orange Leukocyte Cytospin test (AOLC) [Bong, 2003]. For this test, blood that is drawn from the central line is stained with the fluorescent dye acridine orange. Next, microscopic evaluation for the presence of micro-organisms takes place. Implementation of this test might enable to start treatment of the infection and prevent unnecessary removal of non-infected central lines without the necessity to several days wait for culture results.
| Condition | Intervention | Phase |
|---|---|---|
|
Parenteral Nutrition Infection Sepsis |
Drug: taurolidine |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention |
| Official Title: | The AOT (Acridine Orange and Taurolidine) Trial: a Survey on Diagnosis and Prevention of Catheter-Related Infections in Patients on Home Parenteral Nutrition |
- time between episodes of central line infection in one patient
- outcome of acridine orange staining test compared to culture results
| Estimated Enrollment: | 60 |
| Study Start Date: | June 2006 |
| Study Completion Date: | March 2008 |
| Primary Completion Date: | March 2008 (Final data collection date for primary outcome measure) |
Two hypotheses will be tested in the AOT trial:
- The use of taurolidine as an antibiotic lock (5 mL) to flush the central line after infusing the TPN formulation, when compared to the present use of heparin solution (5 mL, 150 E/mL) decreases the rate of catheter-related infections in HPN patients
- Implementation of the acridine orange staining test allows an earlier diagnosis (or rejection of this diagnosis) compared to culture results. Importantly, in the present trial the results of this test will not be used for treatment decisions.
To this end, patients who are admitted to the clinical ward because of suspected central line infection (mostly because of fever and/or chills) will be treated according to the current protocol for catheter sepsis, after obtaining central line and peripheral blood cultures. This protocol includes the administration of medicinase through the central line and i.v. antibiotics peripherally. After obtaining informed consent, in addition 5 cc of EDTA blood will be drawn from the central line to perform (within 24 hours) the acridine orange cytospin staining test and a Gram stain. These results will than be compared to the culture results. Based on culture results, the antibiotics will be tailored.
If the patient recovers and TPN administration can be restarted, randomisation between heparin lock (5 mL, 150 E/mL) versus taurolidine lock solution 2% (5 mL) will take place. In case the catheter has to be removed because of ongoing or recurrent sepsis, randomisation takes place after a new central line has been placed and the patient continues on TPN.
A new episode of proven catheter sepsis is considered as the primary end-point.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- informed consent
- patient on home TPN with central line (Hickman or Porth-a-cath)
- suspected central line infection (acridine orange test)
- proven central line infection (randomisation tauroline vs heparin)
Exclusion Criteria:
- no informed consent
- patient on home TPN with arteriovenous fistula (shunt)
Contacts and Locations| Netherlands | |
| Department of Gastroenterology and Hepatology clinical ward | |
| Nijmegen, Netherlands, 6500 HB | |
| Principal Investigator: | Geert Wanten, MD, PhD | Radboud University Nijmegen Medical Centre, The Netherlands |
More Information
Publications:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | G.Wanten, MD, PhD, MSc, Dept of Gastroenterology and Hepatology |
| ClinicalTrials.gov Identifier: | NCT00321165 History of Changes |
| Other Study ID Numbers: | AOT-trial |
| Study First Received: | May 2, 2006 |
| Last Updated: | February 10, 2009 |
| Health Authority: | Netherlands: The Central Committee on Research Involving Human Subjects (CCMO) |
Keywords provided by Radboud University:
|
nutrition parenteral infection katheter |
taurolidine acridine orange prevention |
Additional relevant MeSH terms:
|
Sepsis Catheter-Related Infections Infection Systemic Inflammatory Response Syndrome Inflammation Pathologic Processes |
Taurolidine Anti-Infective Agents, Local Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Antineoplastic Agents |
ClinicalTrials.gov processed this record on May 19, 2013