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Trials
Published in: Trials 1/2013

Open Access 01-12-2013 | Study protocol

Procalcitonin, pyuria and proadrenomedullin in the management of urinary tract infections – ‘triple p in uti’: study protocol for a randomized controlled trial

Authors: Daniel Drozdov, Anja Thomer, Marc Meili, Stefanie Schwarz, Rita Bossart Kouegbe, Katharina Regez, Merih Guglielmetti, Ursula Schild, Antoinette Conca, Petra Schäfer, Barbara Reutlinger, Cornelia Ottiger, Florian Buchkremer, Alexander Litke, Philipp Schuetz, Andreas Huber, Ulrich Bürgi, Christoph A Fux, Andreas Bock, Beat Müller, Werner C Albrich, the Triple P study group

Published in: Trials | Issue 1/2013

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Abstract

Background

Urinary tract infections (UTIs) are among the most common infectious diseases and drivers of antibiotic use and in-hospital days. A reduction of antibiotic use potentially lowers the risk of antibiotic resistance. An early and adequate risk assessment combining medical, biopsychosocial and functional risk scores has the potential to optimize site-of-care decisions and thus allocation of limited health-care resources. The aim of this factorial design study is twofold: first, for Intervention A, it investigates antibiotic exposure of patients treated with a protocol based on the type of UTI, procalcitonin (PCT) and pyuria. Second, for Intervention B, it investigates the usefulness of the prognostic biomarker proadrenomedullin (ProADM) integrated into an interdisciplinary assessment bundle for site-of-care decisions.

Methods and design

This randomized controlled open-label trial has a factorial design (2 × 2). Randomization of patients will be based on a pre-specified computer-generated randomization list and independent for the two interventions. Adults with UTI presenting to the emergency department (ED) will be screened and enrolled after providing informed consent.
For our first Intervention (A), we developed a protocol based on previous observational research to recommend initiation and duration of antibiotic use based on the clinical presentation of UTI, pyuria and PCT levels. For our second intervention (B), an algorithm was developed to support site-of care decisions based on the prognostic marker ProADM and distinct nursing factors on days 1 and 3. Both interventions will be compared with a control group conforming to the guidelines.
The primary endpoints for the two interventions will be: (A) overall exposure to antibiotics and (B) length of physician-led hospitalization within a follow-up of 30 days. Endpoints are assessed at discharge from hospital, and 30 and 90 days after admission. We plan to screen 300 patients and enroll 250 for an anticipated estimated loss of follow-up of 20%. This will provide adequate power for the two interventions.

Discussion

This trial investigates two strategies for improved individualized medical care in patients with UTI. The minimally effective duration of antibiotic therapy is not known for UTIs, which is important for reducing the selection pressure for antibiotic resistance, costs and drug-related side effects. Triage decisions must be improved to reflect the true medical, biopsychosocial and functional risks in order to allocate patients to the most appropriate care setting and reduce hospital-acquired disability.

Trial registration

Trial registration number:ISRCTN13663741
Appendix
Available only for authorised users
Literature
1.
Lichtenberger P, Hooton TM: Complicated urinary tract infections. Curr Infect Dis Rep. 2008, 10 (6): 499-504. 10.1007/s11908-008-0081-0.CrossRefPubMed
2.
Kollef MH, Fraser VJ: Antibiotic resistance in the intensive care unit. Ann Intern Med. 2001, 134 (4): 298-314.CrossRefPubMed
3.
Hooton TM: Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012, 366 (11): 1028-1037. 10.1056/NEJMcp1104429.CrossRefPubMed
4.
Wagenlehner FM, Schmiemann G, Hoyme U, Funfstuck R, Hummers-Pradier E, Kaase M, Kniehl E, Selbach I, Sester U, Vahlensieck W: National S3 guideline on uncomplicated urinary tract infection: recommendations for treatment and management of uncomplicated community-acquired bacterial urinary tract infections in adult patients. Urologe A. 2011, 50 (2): 153-169. 10.1007/s00120-011-2512-z.CrossRefPubMed
5.
van Nieuwkoop C, van't Wout JW, Assendelft WJ, Elzevier HW, Leyten EM, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Kuijper EJ: Treatment duration of febrile urinary tract infection (FUTIRST trial): a randomized placebo-controlled multicenter trial comparing short (7 days) antibiotic treatment with conventional treatment (14 days). BMC Infect Dis. 2009, 9: 131-10.1186/1471-2334-9-131.CrossRefPubMedPubMedCentral
6.
Sandberg T, Skoog G, Hermansson AB, Kahlmeter G, Kuylenstierna N, Lannergard A, Otto G, Settergren B, Ekman GS: Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012, 380 (9840): 484-490. 10.1016/S0140-6736(12)60608-4.CrossRefPubMed
7.
Drekonja DM, Rector TS, Cutting A, Johnson JR: Urinary tract infection in male veterans: treatment patterns and outcomes. JAMA Intern Med. 2013, 173 (1): 62-68. 10.1001/2013.jamainternmed.829.CrossRefPubMed
8.
Hanberger H, Garcia-Rodriguez JA, Gobernado M, Goossens H, Nilsson LE, Struelens MJ: Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. French and Portuguese ICU Study Groups. JAMA. 1999, 281 (1): 67-71. 10.1001/jama.281.1.67.CrossRefPubMed
9.
Neuhauser MM, Weinstein RA, Rydman R, Danziger LH, Karam G, Quinn JP: Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA. 2003, 289 (7): 885-888. 10.1001/jama.289.7.885.CrossRefPubMed
10.
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011, 52 (5): e103-e120. 10.1093/cid/ciq257.CrossRefPubMed
11.
Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B: Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther. 2010, 8 (5): 575-587. 10.1586/eri.10.25.CrossRefPubMed
12.
Schuetz P, Albrich W, Mueller B: Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011, 9: 107-10.1186/1741-7015-9-107.CrossRefPubMedPubMedCentral
13.
Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M: Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010, 375 (9713): 463-474. 10.1016/S0140-6736(09)61879-1.CrossRefPubMed
14.
Schuetz P, Amin DN, Greenwald JL: Role of procalcitonin in managing adult patients with respiratory tract infections. Chest. 2012, 141 (4): 1063-1073. 10.1378/chest.11-2430.CrossRefPubMed
15.
Ottiger C, Schaer G, Huber AR: Time-course of quantitative urinary leukocytes and bacteria counts during antibiotic therapy in women with symptoms of urinary tract infection. Clin Chim Acta. 2007, 379 (1–2): 36-41.CrossRefPubMed
16.
Everaert K, Delanghe J, Vande Wiele C, Hoebeke P, Dierckx RA, Clarysse B, Lameire N, Oosterlinck W: Urinary alpha 1-microglobulin detects uropathy. A prospective study in 483 urological patients. Clin Chem Lab Med. 1998, 36 (5): 309-315.CrossRefPubMed
17.
Everaert K, Raes A, Hoebeke P, Samijn W, Delanghe J, Vande Wiele C, Vande Walle J: Combined use of urinary alpha1-microglobulin and 99mTc DMSA scintigraphy in the diagnosis and follow-up of acute pyelonephritis and cystitis in children. Eur Urol. 1998, 34 (6): 486-491. 10.1159/000019788.CrossRefPubMed
18.
Horcajada JP, Velasco M, Filella X, Alvarez L, De Lazzari E, Marin JL, Collvinent B, Smithson A, Martinez JA, Noguero M: Evaluation of inflammatory and renal-injury markers in women treated with antibiotics for acute pyelonephritis caused by Escherichia coli. Clin Diagn Lab Immunol. 2004, 11 (1): 142-146.PubMedPubMedCentral
19.
20.
van Nieuwkoop C, Hoppe BP, Bonten TN, Van't Wout JW, Aarts NJ, Mertens BJ, Leyten EM, Koster T, Wattel-Louis GH, Delfos NM: Predicting the need for radiologic imaging in adults with febrile urinary tract infection. Clin Infect Dis. 2010, 51 (11): 1266-1272. 10.1086/657071.CrossRefPubMed
21.
Fontanilla T, Minaya J, Cortes C, Hernando CG, Aranguena RP, Arriaga J, Carmona MS, Alcolado A: Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging. 2012, 37 (4): 639-646. 10.1007/s00261-011-9781-2.CrossRefPubMed
22.
Mitterberger M, Pinggera GM, Colleselli D, Bartsch G, Strasser H, Steppan I, Pallwein L, Friedrich A, Gradl J, Frauscher F: Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography. BJU Int. 2008, 101 (3): 341-344. 10.1111/j.1464-410X.2007.07280.x.CrossRefPubMed
23.
Curns AT, Holman RC, Sejvar JJ, Owings MF, Schonberger LB: Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med. 2005, 165 (21): 2514-2520. 10.1001/archinte.165.21.2514.CrossRefPubMed
24.
Foxman B: Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002, 113 (Suppl 1A): 5S-13S.CrossRefPubMed
25.
Covinsky KE, Pierluissi E, Johnston CB: Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA. 2011, 306 (16): 1782-1793. 10.1001/jama.2011.1556.CrossRefPubMed
26.
Aliyu ZY, Aliyu MH, McCormick K: Determinants for hospitalization in " low-risk" community acquired pneumonia. BMC Infect Dis. 2003, 3: 11-10.1186/1471-2334-3-11.CrossRefPubMedPubMedCentral
27.
Baehni C, Meier S, Spreiter P, Schild U, Regez K, Bossart R, Thomann R, Falconnier C, Christ-Crain M, De Geest S: Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives. BMC Pulm Med. 2010, 10: 12-10.1186/1471-2466-10-12.CrossRefPubMedPubMedCentral
28.
Labarere J, Stone RA, Scott Obrosky D, Yealy DM, Meehan TP, Auble TE, Fine JM, Graff LG, Fine MJ: Factors associated with the hospitalization of low-risk patients with community-acquired pneumonia in a cluster-randomized trial. J Gen Intern Med. 2006, 21 (7): 745-752. 10.1111/j.1525-1497.2006.00510.x.CrossRefPubMedPubMedCentral
29.
Albrich WC, Ruegger K, Dusemund F, Bossart R, Regez K, Schild U, Conca A, Schuetz P, Sigrist T, Huber A: Optimised patient transfer using an innovative multidisciplinary assessment in Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections. Swiss Med Wkly. 2011, 141: w13237-PubMed
30.
Conca A, Bossart R, Regez K, Schild U, Wallimann G, Schweingruber R, Hantikainen V, Tobias P, Albrich W, Ruegger K: OPTIMA - Optimierter Patienten-Transfer durch innovatives multidisziplinäres Assessment. Projektbeschreibung der Phase I. PrInterNet - Zeitschrift für Pflegewissenschaft. 2012, 14 (5): 291-298.
31.
Albrich WC, Ruegger K, Dusemund F, Schuetz P, Arici B, Litke A, Blum CA, Bossart R, Regez K, Schild U: Biomarker-enhanced triage in respiratory infections - a proof-of-concept feasibility trial. Eur Respir J. 2013, Epub ahead of print
32.
Loeb M, Carusone SC, Goeree R, Walter SD, Brazil K, Krueger P, Simor A, Moss L, Marrie T: Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. JAMA. 2006, 295 (21): 2503-2510. 10.1001/jama.295.21.2503.CrossRefPubMed
33.
Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG: A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000, 283 (6): 749-755. 10.1001/jama.283.6.749.CrossRefPubMed
34.
Christ-Crain M, Morgenthaler NG, Struck J, Harbarth S, Bergmann A, Muller B: Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study. Crit Care. 2005, 9 (6): R816-R824. 10.1186/cc3885.CrossRefPubMedPubMedCentral
35.
Albrich WC, Dusemund F, Ruegger K, Christ-Crain M, Zimmerli W, Bregenzer T, Irani S, Buergi U, Reutlinger B, Mueller B: Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis. 2011, 11: 112-10.1186/1471-2334-11-112.CrossRefPubMedPubMedCentral
36.
Litke A, Bossart R, Regez K, Schild U, Guglielmetti M, Conca A, Schafer P, Reutlinger B, Mueller B, Albrich WC: The potential impact of biomarker-guided triage decisions for patients with urinary tract infections. Infection. 2013, Epub ahead of print
37.
Gupta K, Hooton TM, Miller L: Managing uncomplicated urinary tract infection–making sense out of resistance data. Clin Infect Dis. 2011, 53 (10): 1041-1042.CrossRefPubMed
38.
Piaggio G, Elbourne DR, Altman DG, Pocock SJ, Evans SJ: Reporting of noninferiority and equivalence randomized trials: an extension of the CONSORT statement. JAMA. 2006, 295 (10): 1152-1160. 10.1001/jama.295.10.1152.CrossRefPubMed
39.
Regeniter A, Haenni V, Risch L, Kochli HP, Colombo JP, Frei R, Huber AR: Urine analysis performed by flow cytometry: reference range determination and comparison to morphological findings, dipstick chemistry and bacterial culture results–a multicenter study. Clin Nephrol. 2001, 55 (5): 384-392.PubMed
40.
Neuner EA, Sekeres J, Hall GS, van Duin D: Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms. Antimicrob Agents Chemother. 2012, 56 (11): 5744-5748. 10.1128/AAC.00402-12.CrossRefPubMedPubMedCentral
41.
Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, Neidert S, Fricker T, Blum C, Schild U: Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009, 302 (10): 1059-1066. 10.1001/jama.2009.1297.CrossRefPubMed
42.
Muller B, Christ-Crain M, Schuetz P: Meta-analysis of procalcitonin for sepsis detection. Lancet Infect Dis. 2007, 7 (8): 498-499. 10.1016/S1473-3099(07)70163-9. author reply 502–493CrossRefPubMed
43.
Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E: Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection?–results of a randomized controlled pilot trial. BMC Med. 2010, 8: 30-10.1186/1741-7015-8-30.CrossRefPubMedPubMedCentral
44.
Falagas ME, Kotsantis IK, Vouloumanou EK, Rafailidis PI: Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect. 2009, 58 (2): 91-102. 10.1016/j.jinf.2008.12.009.CrossRefPubMed
45.
Louis Simonet M, Kossovsky MP, Chopard P, Sigaud P, Perneger TV, Gaspoz JM: A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility. BMC Health Serv Res. 2008, 8: 154-10.1186/1472-6963-8-154.CrossRefPubMedPubMedCentral
46.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007, 44 (Suppl 2): S27-S72.CrossRefPubMed
47.
Große Schlarmann J: Der CMS© im ePA©. Verschiedene Qualitätsdimensionen eines Instruments. Eine empirische Analyse. 2007, Faculty of Health: Private University Witten/Herdecke, Gelsenkirchen, Germany
48.
Yealy DM, Auble TE, Stone RA, Lave JR, Meehan TP, Graff LG, Fine JM, Obrosky DS, Mor MK, Whittle J: Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005, 143 (12): 881-894.CrossRefPubMed
49.
Christ-Crain M, Morgenthaler NG, Stolz D, Muller C, Bingisser R, Harbarth S, Tamm M, Struck J, Bergmann A, Muller B: Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care. 2006, 10 (3): R96-10.1186/cc4955.CrossRefPubMedPubMedCentral
50.
Huang DT, Angus DC, Kellum JA, Pugh NA, Weissfeld LA, Struck J, Delude RL, Rosengart MR, Yealy DM: Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest. 2009, 136 (3): 823-831. 10.1378/chest.08-1981.CrossRefPubMedPubMedCentral
51.
Stolz D, Christ-Crain M, Morgenthaler NG, Miedinger D, Leuppi J, Muller C, Bingisser R, Struck J, Muller B, Tamm M: Plasma pro-adrenomedullin but not plasma pro-endothelin predicts survival in exacerbations of COPD. Chest. 2008, 134 (2): 263-272. 10.1378/chest.08-0047.CrossRefPubMed
52.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C: A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009, 150 (3): 178-187.CrossRefPubMedPubMedCentral
53.
Schrag A, Selai C, Jahanshahi M, Quinn NP: The EQ-5D–a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2000, 69 (1): 67-73. 10.1136/jnnp.69.1.67.CrossRefPubMedPubMedCentral
54.
McGreevy KM, Lipsitz SR, Linder JA, Rimm E, Hoel DG: Using median regression to obtain adjusted estimates of central tendency for skewed laboratory and epidemiologic data. Clin Chem. 2009, 55 (1): 165-169.CrossRefPubMed
55.
Albrich WC, Dusemund F, Bucher B, Meyer S, Thomann R, Kuhn F, Bassetti S, Sprenger M, Bachli E, Sigrist T: Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life": an international, multicenter poststudy survey (ProREAL). Arch Intern Med. 2012, 172 (9): 715-722. 10.1001/archinternmed.2012.770.CrossRefPubMed
56.
Montgomery AA, Peters TJ, Little P: Design, analysis and presentation of factorial randomised controlled trials. BMC Med Res Methodol. 2003, 3: 26-10.1186/1471-2288-3-26.CrossRefPubMedPubMedCentral
57.
Green S, Liu PY, O'Sullivan J: Factorial design considerations. J Clin Oncol. 2002, 20 (16): 3424-3430. 10.1200/JCO.2002.03.003.CrossRefPubMed
58.
Schuetz P, Wolbers M, Christ-Crain M, Thomann R, Falconnier C, Widmer I, Neidert S, Fricker T, Blum C, Schild U: Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Crit Care. 2010, 14 (3): R106-10.1186/cc9055.CrossRefPubMedPubMedCentral
59.
Rautakorpi UM, Lumio J, Huovinen P, Klaukka T: Indication-based use of antimicrobials in Finnish primary health care. Description of a method for data collection and results of its application. Scand J Prim Health Care. 1999, 17 (2): 93-99. 10.1080/028134399750002719.CrossRefPubMed
60.
Woodford HJ, George J: Diagnosis and management of urinary tract infection in hospitalized older people. J Am Geriatr Soc. 2009, 57 (1): 107-114. 10.1111/j.1532-5415.2008.02073.x.CrossRefPubMed
61.
Vonberg RP, Behnke M, Ruden H, Gastmeier P: Costs due to urinary tract infections in Germany. An estimation based on the data from the German National Nosocomial Infections Surveillance System. Urologe A. 2008, 47 (1): 54-58. 10.1007/s00120-007-1597-x.CrossRefPubMed
62.
Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, Angus DC: Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008, 52 (1): 48-58. 10.1016/j.annemergmed.2008.01.003. e42CrossRefPubMedPubMedCentral
63.
Chalmers JD, Al-Khairalla M, Short PM, Fardon TC, Winter JH: Proposed changes to management of lower respiratory tract infections in response to the Clostridium difficile epidemic. J Antimicrob Chemother. 2010, 65 (4): 608-618. 10.1093/jac/dkq038.CrossRefPubMed
Metadata
Title
Procalcitonin, pyuria and proadrenomedullin in the management of urinary tract infections – ‘triple p in uti’: study protocol for a randomized controlled trial
Authors
Daniel Drozdov
Anja Thomer
Marc Meili
Stefanie Schwarz
Rita Bossart Kouegbe
Katharina Regez
Merih Guglielmetti
Ursula Schild
Antoinette Conca
Petra Schäfer
Barbara Reutlinger
Cornelia Ottiger
Florian Buchkremer
Alexander Litke
Philipp Schuetz
Andreas Huber
Ulrich Bürgi
Christoph A Fux
Andreas Bock
Beat Müller
Werner C Albrich
the Triple P study group
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Trials / Issue 1/2013
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-14-84

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