Ignite Creation Date:
2024-05-06 @ 8:17 PM
Last Modification Date:
2024-10-26 @ 3:24 PM
Study NCT ID:
NCT06323668
Status:
NOT_YET_RECRUITING
Last Update Posted:
2024-03-21
First Post:
2024-03-07
Brief Title:
Cardiac Implantable Electronic Device remOval Versus Full coUrse Medical Treatment
Sponsor:
Rigshospitalet Denmark
Organization:
Rigshospitalet Denmark
Study Overview
Official Title:
Cardiac Implantable Electronic Device remOval Versus Full coUrse Medical Treatment - The CIEDOUT Study - A Randomized Clinical Trial
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-03
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
CIEDOUT
Brief Summary:
The CIEDOUT study is an open label randomized trial in patients with possible cardiac implantable electronic device CIED infection
The hypothesis is that CIED removal guideline antibiotic therapy is better than 6-weeks antibiotic therapy alone in preventing death or relapse of bacteremia in patients with bacteremia and possible CIED infection not definite CIED infection
The objective of this study is to test whether CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy alone in prevention of the composite endpoint of death or relapse bacteremia after 6 months of follow-up in patients with CIED and systemic infection but without definite CIED infection
The hypothesis is that CIED removal guideline antibiotic therapy is better than 6-weeks antibiotic therapy alone in preventing death or relapse of bacteremia in patients with bacteremia and possible CIED infection not definite CIED infection
The objective of this study is to test whether CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy alone in prevention of the composite endpoint of death or relapse bacteremia after 6 months of follow-up in patients with CIED and systemic infection but without definite CIED infection
Detailed Description:
Complete removal of cardiac implantable electronic devices CIEDs is recommended for all patients with confirmed CIED infection under initial empirical antibiotic therapy by guidelines However the current 2023 European Society of Cardiology ESC guidelines on treatment of possible CIED infection are mostly based on expert opinions andor observational studies No previous randomized clinical trial has been conducted why the CIEDOUT study is the first randomized clinical trial with high evidence investigating treatment of possible CIED infections The CIEDOUT study will affect future clinical guidelines and optimize treatment and prognosis for future patients with possible CIED infection
The hypothesis is that CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy alone in preventing death or relapse of bacteremia in patients with bacteremia and possible CIED infection not definite CIED infection The investigators want to test whether CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy in prevention of the composite endpoint of death or relapse bacteremia after 6 months of follow-up in patients with CIED and systemic infection but without definite CIED infection
The study is a randomized open label trial Patients will be allocated by 11 randomization to CIED extraction guideline antibiotic therapy or 6-weeks antibiotic therapy alone The primary outcome is a composite endpoint of death or relapse bacteremia same microorganism within 6 months after randomization The secondary outcomes are days alive and out-of-hospital to 6 months death readmission for any cause device extraction relapse of bacteremia the same microorganism relapse of bacteremia all species and definite CIED infection
All patients suspected of CIED infection or patients with bacteremia CIED will be screened for inclusion in the CIEDOUT study according to the ESC modified diagnosis criteria To enable timely identification of possible candidates a surveillance system will be set up combining data from The Danish Pacemaker and implantable cardioverter-defibrillator ICD registry and then real-time bacteremia surveillance data through The Danish nationwide clinical Microbiology Database MiBa Hence whenever a relevant bacteremia is identified the CIED registry will then by queried for whether that patient also has CIED Randomization allocation ratio is 11 through a computerized application via RedCap Patients will be entered into the intention to treat analysis
The patients will be randomized to CIED removal andor medical therapy at least 10 days iv antibiotic therapy and then per oral treatment to 6 weeks total by POET criteria The CIED removal will be done as soon as possible within 7 days The study-outcomes will be assessed at three routine clinical check-ups as part of the standard treatment at 1 week 4 weeks and 3 months after randomization Within 6 months after randomization patients will be followed for outcomes through medical charts and the national health registries After that the patients will be assessed for outcomes on an annual basis by medical chart review and the Danish nationwide registries
The total trial duration is expected to be 14 years Inclusion period for the main paper is expected to be 4 years and then follow-up for 3 months for the last included patients Hereafter patients will be followed for outcomes annually through medical charts and the national health registries up to 10 years after the last included patient until 2038
Based on prior studies and especially preliminary data it is estimated that approximately 29 of patients will experience a primary event by 6 months in the medical treatment group and 12 in the extraction group In order to have 80 power to detect difference in total primary endpoints between the treatment groups at least 174 patients will be needed 87 in each study arm over a median follow-up of 3 years to be able to reject the null hypothesis with a power of 80 and a risk of type I error of 5 Assuming a steady rate of patients with the inclusion criteria there will be approximately 100 incident cases available for the CIEDOUT study annually in Eastern Denmark based on preliminary data If 60 of these consent to the study 60 incident patients per year will be included By 3 years 180 incident patients will then be included
The hypothesis is that CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy alone in preventing death or relapse of bacteremia in patients with bacteremia and possible CIED infection not definite CIED infection The investigators want to test whether CIED removal guideline antibiotic therapy is superior to 6-weeks antibiotic therapy in prevention of the composite endpoint of death or relapse bacteremia after 6 months of follow-up in patients with CIED and systemic infection but without definite CIED infection
The study is a randomized open label trial Patients will be allocated by 11 randomization to CIED extraction guideline antibiotic therapy or 6-weeks antibiotic therapy alone The primary outcome is a composite endpoint of death or relapse bacteremia same microorganism within 6 months after randomization The secondary outcomes are days alive and out-of-hospital to 6 months death readmission for any cause device extraction relapse of bacteremia the same microorganism relapse of bacteremia all species and definite CIED infection
All patients suspected of CIED infection or patients with bacteremia CIED will be screened for inclusion in the CIEDOUT study according to the ESC modified diagnosis criteria To enable timely identification of possible candidates a surveillance system will be set up combining data from The Danish Pacemaker and implantable cardioverter-defibrillator ICD registry and then real-time bacteremia surveillance data through The Danish nationwide clinical Microbiology Database MiBa Hence whenever a relevant bacteremia is identified the CIED registry will then by queried for whether that patient also has CIED Randomization allocation ratio is 11 through a computerized application via RedCap Patients will be entered into the intention to treat analysis
The patients will be randomized to CIED removal andor medical therapy at least 10 days iv antibiotic therapy and then per oral treatment to 6 weeks total by POET criteria The CIED removal will be done as soon as possible within 7 days The study-outcomes will be assessed at three routine clinical check-ups as part of the standard treatment at 1 week 4 weeks and 3 months after randomization Within 6 months after randomization patients will be followed for outcomes through medical charts and the national health registries After that the patients will be assessed for outcomes on an annual basis by medical chart review and the Danish nationwide registries
The total trial duration is expected to be 14 years Inclusion period for the main paper is expected to be 4 years and then follow-up for 3 months for the last included patients Hereafter patients will be followed for outcomes annually through medical charts and the national health registries up to 10 years after the last included patient until 2038
Based on prior studies and especially preliminary data it is estimated that approximately 29 of patients will experience a primary event by 6 months in the medical treatment group and 12 in the extraction group In order to have 80 power to detect difference in total primary endpoints between the treatment groups at least 174 patients will be needed 87 in each study arm over a median follow-up of 3 years to be able to reject the null hypothesis with a power of 80 and a risk of type I error of 5 Assuming a steady rate of patients with the inclusion criteria there will be approximately 100 incident cases available for the CIEDOUT study annually in Eastern Denmark based on preliminary data If 60 of these consent to the study 60 incident patients per year will be included By 3 years 180 incident patients will then be included
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None