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Excluded versus included patients in a randomized controlled trial of infections caused by carbapenem-resistant Gram-negative bacteria: relevance to external validity.

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  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: London : BioMed Central, [2001-
    • الموضوع:
      Drug Resistance, Bacterial*; Acinetobacter Infections/*drug therapy ; Anti-Bacterial Agents/*therapeutic use; Acinetobacter Infections/microbiology ; Acinetobacter baumannii/isolation & purification ; Aged ; Carbapenems/therapeutic use ; Colistin/therapeutic use ; Female ; Greece ; Humans ; Israel ; Italy ; Logistic Models ; Male ; Meropenem/therapeutic use ; Middle Aged ; Randomized Controlled Trials as Topic ; Treatment Outcome
    • نبذة مختصرة :
      Background: Population external validity is the extent to which an experimental study results can be generalized from a specific sample to a defined population. In order to apply the results of a study, we should be able to assess its population external validity. We performed an investigator-initiated randomized controlled trial (RCT) (AIDA study), which compared colistin-meropenem combination therapy to colistin monotherapy in the treatment of patients infected with carbapenem-resistant Gram-negative bacteria. In order to examine the study's population external validity and to substantiate the use of AIDA study results in clinical practice, we performed a concomitant observational trial.
      Methods: The study was conducted between October 1st, 2013 and January 31st, 2017 (during the RCTs recruitment period) in Greece, Israel and Italy. Patients included in the observational arm of the study have fulfilled clinical and microbiological inclusion criteria but were excluded from the RCT due to receipt of colistin for > 96 h, refusal to participate, or prior inclusion in the RCT. Non-randomized cases were compared to randomized patients. The primary outcome was clinical failure at 14 days of infection onset.
      Results: Analysis included 701 patients. Patients were infected mainly with Acinetobacter baumannii [78.2% (548/701)]. The most common reason for exclusion was refusal to participate [62% (183/295)]. Non-randomized and randomized patients were similar in most of the demographic and background parameters, though randomized patients showed minor differences towards a more severe infection. Combination therapy was less common in non-randomized patients [31.9% (53/166) vs. 51.2% (208/406), p = 0.000]. Randomized patients received longer treatment of colistin [13 days (IQR 10-16) vs. 8.5 days (IQR 0-15), p = 0.000]. Univariate analysis showed that non-randomized patients were more inclined to clinical failure on day 14 from infection onset [82% (242/295) vs. 75.5% (307/406), p = 0.042]. After adjusting for other variables, non-inclusion was not an independent risk factor for clinical failure at day 14.
      Conclusion: The similarity between the observational arm and RCT patients has strengthened our confidence in the population external validity of the AIDA trial. Adding an observational arm to intervention studies can help increase the population external validity and improve implementation of study results in clinical practice.
      Trial Registration: The trial was registered with ClinicalTrials.gov, number NCT01732250 on November 22, 2012.
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    • Grant Information:
      Health-F3-2011-278348 EU AIDA; 2016/80 Israel National Institute for Health Policy Research (IL)
    • Contributed Indexing:
      Keywords: Antibiotic treatment; Antimicrobial resistance; Population external validity
    • Molecular Sequence:
      ClinicalTrials.gov NCT01732250
    • الرقم المعرف:
      0 (Anti-Bacterial Agents)
      0 (Carbapenems)
      FV9J3JU8B1 (Meropenem)
      Z67X93HJG1 (Colistin)
    • الموضوع:
      Date Created: 20210401 Date Completed: 20210419 Latest Revision: 20210419
    • الموضوع:
      20231215
    • الرقم المعرف:
      PMC8010276
    • الرقم المعرف:
      10.1186/s12879-021-05995-y
    • الرقم المعرف:
      33789574