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Antimicrobial Prophylaxis in Patients Who Underwent a Transurethral Resection of Bladder (TURB)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04209192
Recruitment Status : Recruiting
First Posted : December 24, 2019
Last Update Posted : January 10, 2020
Sponsor:
Collaborator:
Laboratorios Senosiain, S.A. de C.V.
Information provided by (Responsible Party):
Ricardo Alonso Castillejos Molina, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran

Brief Summary:

Antimicrobial prophylaxis in urological procedures is aimed to reduce the risk of local and systemic postoperative infections such as urinary tract infection or surgical site infection. It should be recommended only when the potential benefit exceeds the anticipated risks and costs. However, a wide variation in the use of periprocedural prophylactic antibiotics has been demonstrated, which frequently is incurred as an inappropriate selection of antimicrobials, inadequate schedule of administration or excessive duration of prophylaxis.

The increase in multidrug resistance of antibiotics in recent decades has been associated with its misuse, resulting in an increased rate of morbidity and mortality, prolonged hospital stays and increased care costs. Specifically, resistance to fluoroquinolones has increased its prevalence, a group of antibiotics widely used in urology. Therefore, local resistance patterns should be considered before following recommendations, especially in populations with poor control of antimicrobial use.

Transurethral resection of bladder (TURB) has become a frequent surgical procedure, as it is the main diagnostic and therapeutic tool for bladder cancer, representing the ninth most common malignancy in the world. However, no recent randomized clinical trial has investigated antimicrobial prophylaxis for TURB. It is well known that an expected complication of TURB is urinary tract infection (UTI), which is the most common healthcare related infection worldwide.

Under this premise, a randomized clinical trial is proposed to analyze the current panorama of UTI as a transcendent postoperative complication of TURB, under the context of the new emerging resistance parameters. The use of fosfomycin trometamol is proposed as a good potential option for urological procedures due to its high activity against multidrug-resistant gram-negative bacteria and its favorable pharmacokinetic parameters that guarantees wide tissue penetration and a high urinary concentration, in a single dose, the which will be compared with the control group with traditional prophylaxis (amikacin). The relative risk of UTI will be estimated, as well as the attributable risk of the main risk factors associated with this infection, allowing a better characterization of this population for adequate decision making regarding this clinical challenge.


Condition or disease Intervention/treatment Phase
Urinary Tract Infections Bladder Cancer Urologic Surgical Procedures Drug: Fosfomycin Tromethamine 3G Sachet Drug: Amikacin Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 75 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Care Provider, Investigator)
Primary Purpose: Prevention
Official Title: Randomized Phase II Study of Antibiotic Prophylaxis With Fosfomycin vs Amikacin in Transurethral Resection of Bladder
Actual Study Start Date : January 1, 2020
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : February 2023


Arm Intervention/treatment
Active Comparator: Control group (Amikacin)

Patients in the control group will receive amikacin as prophylactic antibiotic. It will be administered intravenously 30 minutes before procedure. Patients with an estimated glomerular filtration rate (EGFR) greater or equal than 70 ml/min will receive 1 gram of Amikacin. Patients with an EGFR less than 70 ml/min will received a calculated dose following the next parameters.

Patients with EGFR between 69-40 ml/min should receive: the calculated GFR x 0.18 = mg/kg.

Patients with EGFR less than 40 ml/min should receive: the calculated GFR x 0.36 = mg/kg.

Drug: Amikacin
Is the prophylactic drug which will be used in the control group.
Other Name: Control

Experimental: Intervention group (Fosfomycin)
Patients in the intervention group will receive Fosfomycin trometamol as prophylactic antibiotic. It will be administered orally in the night before procedure. Patients must be on fasting and will receive 3 grams.
Drug: Fosfomycin Tromethamine 3G Sachet
Is the prophylactic drug which will be used in the intervention group.
Other Name: Fosfomycin




Primary Outcome Measures :
  1. Incidence of urinary tract infection after transurethral resection of bladder [ Time Frame: 30 days after procedure ]

    Measurement tool: Clinical manifestations of urinary tract infection plus positive urine culture.

    Measurement unit: Colony-forming unit (CFU) per milliliter (mL) depending on how the urine sample was took. A positive urine culture will be confirmed using the next parameters: For midstream urine a count greater or equal to 100,000 CFU/mL and for urine obtained from a urethral catheter a count a count greater or equal to 100 CFU/mL Clinical manifestations of urinary tract infection: Patient presenting 1 or more of the following signs or symptoms: fever, dysuria, frequency, hematuria, lumbar pain, costovertebral angle tenderness)


  2. Incidence of asymptomatic bacteriuria after transurethral resection of bladder [ Time Frame: 30 days after procedure ]
    Measurement tool: Positive urine culture and no clinical manifestation of urinary tract infection Measurement unit: Colony-forming unit (CFU) per milliliter (mL) depending on how the urine sample was took. A urine culture will be positive using the next parameters: For midstream urine a count greater or equal to 100,000 CFU/mL and for urine obtained from a urethral catheter a count a count greater or equal to 100 CFU/mL No clinical manifestations of urinary tract infection

  3. Relative risk of asymptomatic bacteriuria after transurethral resection of bladder [ Time Frame: 30 days after procedure ]
    Measurement tool: Positive urine culture and no clinical manifestation of urinary tract infection Measurement unit: Colony-forming unit (CFU) per milliliter (mL) depending on how the urine sample was took. A urine culture will be positive using the next parameters: For midstream urine a count greater or equal to 100,000 CFU/mL and for urine obtained from a urethral catheter a count a count greater or equal to 100 CFU/mL No clinical manifestations of urinary tract infection

  4. Relative Risk of urinary tract infection after transurethral resection of bladder [ Time Frame: 30 days after procedure ]

    Measurement tool: Clinical manifestations of urinary tract infection plus positive urine culture.

    Measurement unit: Colony-forming unit (CFU) per milliliter (mL) depending on how the urine sample was took. A positive urine culture will be confirmed using the next parameters: For midstream urine a count greater or equal to 100,000 CFU/mL and for urine obtained from a urethral catheter a count a count greater or equal to 100 CFU/mL Clinical manifestations of urinary tract infection: Patient presenting 1 or more of the following signs or symptoms: fever, dysuria, frequency, hematuria, lumbar pain, costovertebral angle tenderness)



Secondary Outcome Measures :
  1. Relative risk of patients presenting a single bladder tumor [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented a single tumor: positive Patients presenting more than 1 tumor: negative

  2. % of patients presenting a single bladder tumor [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented a single tumor: positive Patients presenting more than 1 tumor: negative

  3. Relative risk of patients presenting 2 to 7 bladder tumors [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented 2 to 7 tumors: positive Patients that presented more than 7 tumors or a single tumor: negative

  4. % of patients presenting 2 to 7 bladder tumors [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented 2 to 7 tumors: positive Patients that presented more than 7 tumors or a single tumor: negative

  5. Relative risk of patients presenting more than 7 bladder tumors [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented more than 7 tumors: positive Patients that presented less than 8 tumors: negative

  6. % of patients presenting more than 7 bladder tumors [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patients that presented more than 7 tumors: positive Patients that presented less than 8 tumors: negative

  7. Relative risk of bleeding during surgery [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: milliliters

  8. Relative risk of patients with I on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with I ASA classification: Positive Patient with other ASA classification not being I: Negative

  9. % of patients with I on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with I ASA classification: Positive Patient with other ASA classification not being I: Negative

  10. Relative risk of patients with II on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with II ASA classification: Positive Patient with other ASA classification not being II: Negative

  11. % of patients with II on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with II ASA classification: Positive Patient with other ASA classification not being II: Negative

  12. Relative risk of patients with III on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with III ASA classification: Positive Patient with other ASA classification not being III: Negative

  13. % of patients with III on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with III ASA classification: Positive Patient with other ASA classification not being III: Negative

  14. Relative risk of patients with IV on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with IV ASA classification: Positive Patient with other ASA classification not being IV: Negative

  15. % of patients with IV on ASA classification [ Time Frame: During procedure ]
    Measurement tool: Observation of the procedure and report of data collection sheet Measurement unit: Patient with IV ASA classification: Positive Patient with other ASA classification not being IV: Negative

  16. Relative risk of patients with a urethral catheter removed 24 hours after procedure [ Time Frame: 1 day after procedure ]
    Measurement tool: Observation of the procedure, report of data collection sheet and follow up note review Measurement unit: Patient with a urethral catheter removed 24 hours after procedure: positive Patient with a urethral catheter after 24 hours after procedure: negative

  17. % of patients with a urethral catheter removed 24 hours after procedure [ Time Frame: 1 day after procedure ]
    Measurement tool: Observation of the procedure, report of data collection sheet and follow up note review Measurement unit: Patient with a urethral catheter removed 24 hours after procedure: positive Patient with a urethral catheter after 24 hours after procedure: negative

  18. Relative risk of muscle invasive bladder cancer [ Time Frame: 30 days after procedure ]

    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other)

    Measurement tool: Histopathology report Measurement unit: Patient with muscle invasive bladder cancer: Positive Patient with non-muscle invasive bladder cancer or chronic cystitis: Negative


  19. % of patients with muscle invasive bladder cancer [ Time Frame: 30 days after procedure ]
    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other) Measurement tool: Histopathology report Measurement unit: Patient with muscle invasive bladder cancer: Positive Patient with non-muscle invasive bladder cancer or chronic cystitis: Negative

  20. Relative risk of non-muscle invasive bladder cancer [ Time Frame: 30 days after procedure ]
    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other) Measurement tool: Histopathology report Measurement unit: Patient with non-muscle invasive cancer: Positive Patient with muscle invasive cancer or chronic cystitis: Negative

  21. % of patients with non-muscle invasive bladder cancer [ Time Frame: 30 days after procedure ]
    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other) Measurement tool: Histopathology report Measurement unit: Patient with non-muscle invasive bladder cancer: Positive Patient with muscle invasive bladder cancer or chronic cystitis: Negative

  22. Relative risk of chronic cystitis [ Time Frame: 30 days after procedure ]
    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other) Measurement tool: Histopathology report Measurement unit: Patient with chronic cystitis: Positive Patient with non-muscle invasive bladder cancer or muscle invasive bladder cancer: Negative

  23. % of patients with chronic cystitis [ Time Frame: 30 days after procedure ]
    Based on the results of the histopathology report, the patients will be classified in nominal groups (non-muscle invasive bladder tumor, muscle invasive bladder tumor, chronic cystitis or other) Measurement tool: Histopathology report Measurement unit: Patient with chronic cystitis: Positive Patient with non-muscle invasive bladder cancer or muscle invasive bladder cancer: Negative

  24. Relative risk of number of days of urethral catheter after procedure [ Time Frame: 30 days after procedure ]
    Measurement tool: Observation of the procedure, report of data collection sheet and follow up note review Measurement unit: Number of days of urethral catheter after procedure


Other Outcome Measures:
  1. Relative risk of positive nitrites in preoperative urinalysis [ Time Frame: 30 days before procedure ]
    Measurement tool: Urinalysis Measurement unit: Presence of nitrites in urinalysis: positive. Absence of nitrites in urinalysis: negative

  2. Relative risk of positive leukocytes in urine in preoperative urinalysis [ Time Frame: 30 days before procedure ]

    Measurement tool: Urinalysis and microscopy Measurement unit: Presence of 0-5 leukocytes per field in urinalysis: negative.

    Presence of 6 or more leukocytes per field in urinalysis: positive


  3. Relative risk of positive erythrocytes in urine in preoperative urinalysis [ Time Frame: 30 days before procedure ]

    Measurement tool: Urinalysis and microscopy Measurement unit: Presence of 0-2 erythrocytes per field in urinalysis: negative.

    Presence of 3 or more erythrocytes per field in urinalysis: positive


  4. Relative risk of antibiotic use in the past 3 months [ Time Frame: 15 days before procedure ]

    Measurement tool: Interrogation and questionnaire Measurement unit: Use of antibiotics in the past 3 months before procedure: positive.

    No use of antibiotics in the past 3 months before procedure: negative.


  5. % of patients that used antibiotics in the past 3 months [ Time Frame: 15 days before procedure ]

    Measurement tool: Interrogation and questionnaire Measurement unit: Use of antibiotics in the past 3 months before procedure: positive.

    No use of antibiotics in the past 3 months before procedure: negative.


  6. Relative risk of patients that had a urinary tract infection before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Number of times the patient had a urinary tract infection before procedure.

  7. % of patients that had an urinary tract infection before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Number of times the patient had a urinary tract infection before procedure.

  8. Relative risk of patients that had a urological surgery before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patients had a urological surgery before procedure: positive Patient did not had a urological surgery before procedure: negative

  9. % of patients that had a urological surgery before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patients had a urological surgery before procedure: positive Patient did not had a urological surgery before procedure: negative

  10. Relative risk of patients that had a cystoscopy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had cystoscopy before procedure: positive Patient did not had a cystoscopy before procedure: negative

  11. % of patients that had a cystoscopy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had cystoscopy before procedure: positive Patient did not had a cystoscopy before procedure: negative

  12. Relative risk of patients that have a urinary malformation before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had urinary malformation before procedure: positive Patient did not had a urinary malformation before procedure: negative

  13. % of patients that have a urinary malformation before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had urinary malformation before procedure: positive Patient did not had a urinary malformation before procedure: negative

  14. Relative risk of patients that had obstructive uropathy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had obstructive uropathy before procedure: positive Patient did not had a obstructive uropathy before procedure: negative

  15. % of patients that had obstructive uropathy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had obstructive uropathy before procedure: positive Patient did not had a obstructive uropathy before procedure: negative

  16. Relative risk of patients that had vesicoureteral reflux before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had vesicoureteral reflux before procedure: positive Patient did not had vesicoureteral reflux before procedure: negative

  17. % of patients that had vesicoureteral reflux before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Patient had vesicoureteral reflux before procedure: positive Patient did not had vesicoureteral reflux before procedure: negative

  18. Relative risk of patients that had a transurethral resection of bladder before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Number of times the patient had a transurethral resection of bladder tumor before procedure

  19. % patients that did not had a transurethral resection of bladder before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation, questionnaire and clinical file review. Measurement unit: Number of times the patient had a transurethral resection of bladder tumor before procedure

  20. Relative risk of patients who received intravesical chemotherapy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation and questionnaire Measurement unit: Use of intravesical chemotherapy before procedure: positive. Use of intravesical chemotherapy before procedure: negative.

  21. % of patients who received intravesical chemotherapy before procedure [ Time Frame: 15 days before procedure ]
    Measurement tool: Interrogation and questionnaire Measurement unit: Use of intravesical chemotherapy before procedure: positive. Patient did not had intravesical chemotherapy before procedure: negative.

  22. Relative risk of patients who received intravesical immunotherapy with BCG before procedure [ Time Frame: 15 days before procedure ]

    Measurement tool: Interrogation and questionnaire Measurement unit: Use of intravesical immunotherapy with BCG before procedure: positive.

    Patient did not had intravesical immunotherapy with BCG before procedure: negative.


  23. % of patients who received intravesical immunotherapy with BCG before procedure [ Time Frame: 15 days before procedure ]

    Measurement tool: Interrogation and questionnaire Measurement unit: Use of intravesical immunotherapy with BCG before procedure: positive.

    Patient did not had intravesical immunotherapy with BCG before procedure: negative.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients 18 years old of age
  • Patients with a programmed TURB
  • Absence of urinary tract infection (negative urine culture and no clinical manifestations for urinary tract infection)

Exclusion Criteria:

  • Patients with asymptomatic bacteriuria
  • Patients with positive urine culture before procedure
  • Patients with urinary catheterization

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04209192


Contacts
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Contact: Ricardo A Castillejos-Molina, MD 5254870900 ext 7252 rcastillejos@hotmail.com

Locations
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Mexico
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Recruiting
Mexico City, Mexico, 14080
Contact: Ricardo A Castillejos-Molina, MD    5254870900 ext 7252    rcastillejos@hotmail.com   
Contact: Arturo Galindo-Fraga, MSc    5254870900 ext 6101    galindofraga@yahoo.com   
Principal Investigator: Ricardo A Castillejos-Molina, MD         
Sub-Investigator: María D Niembro-Ortega, MD         
Sub-Investigator: Adrián M Garza-Gangemi, MD         
Sub-Investigator: David Gomez-Ortiz, MD         
Sub-Investigator: Guillermo H Martinez-Delgado, MD         
Sponsors and Collaborators
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Laboratorios Senosiain, S.A. de C.V.
Investigators
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Principal Investigator: Ricardo A Castillejos, MD Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Publications:
Mayorga, G; Ibarra, O; Sedano, B; Trujillo, O; Cornejo, D; Palmeros, R;…Pacheco, G. (2014) Aplicación de nomogramas en México para cáncer de vejiga en pacientes del Hospital General "Dr Manuel Gea González". Revista Mexicana de Urología, 74(1),3-8. https://doi.org/10.1016/s2007-4085(15)30002-1
Sedano-Basilio, J; Mayorga-Gómez, E; Garza-Sainz, G; Conrejo-Dávila, V; Uberetagoyena-Tello de Meneses, I; Palmeros-Rodríguez, A;… Pacheco-Gahbler, C. (2016) Epidemiología de los tumores genitourinarios en una década. Revista Mexicana de Urología, 76(3), 131-140. https://doi.org/10.1016/j.uromx.2016.01.004
Pycha, A. & Palermo, S. (2005) Transurethral Resection of Bladder Tumors. In R. Hoenfellner & J. Stolzenburg (Eds.) Manual Endourology (pp. 55-70) Berlín: Springer
Rolston K.V. (2003) Pseudomonas Aeruginosa Infections in Cancer Patients. In: Hauser A.R., Rello J. (eds) Severe Infections Caused by Pseudomonas Aeruginosa. Perspectives on Critical Care Infectious Diseases, vol 7. Springer, Boston, MA
Sotomayor-de Zavaleta, M; Ponce de León-Garduño, A; Guzmán-Esquivel, J. & Rosas-Nava, E. (2015). Recomendaciones de expertos mexicanos en en tratamiento de las infecciones del tracto urinario en pacientes adultos, embarazadas y niños. Revista Mexicana de Urología, 72 (2), 1-46
Junuzovic, D; Hasanbegovic, M. & Kovacevic-Prstojevic, J (2011) The Incidence of Acquired Urinary Tract Infections in patients After Transurethral Resection of Bladder Tumors. MSM, 23 (2): 91-92

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Responsible Party: Ricardo Alonso Castillejos Molina, Urology Attending, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
ClinicalTrials.gov Identifier: NCT04209192    
Other Study ID Numbers: URO-2995-19-20-1
First Posted: December 24, 2019    Key Record Dates
Last Update Posted: January 10, 2020
Last Verified: January 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Ricardo Alonso Castillejos Molina, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran:
UTI
Prophylaxis
Urinary Tract Infections
TURB
Fosfomycin
Amikacin
Transurethral Resection of Bladder
Additional relevant MeSH terms:
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Urinary Tract Infections
Infection
Urologic Diseases
Amikacin
Fosfomycin
Anti-Bacterial Agents
Anti-Infective Agents