Rapid Detection of Staphylococcus Aureus in Burn Patients

Study Overview
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Brief Summary
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The purpose of this study is to determine if rapid early detection of the bacteria causing sepsis in burn patients improves patient outcomes.

Detailed Description
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Burn patients have lost their primary barrier to microorganism invasion and therefore are continually and chronically exposed to pathogens. Ninety-seven percent of patients with >20% total body surface area (TBSA) burns develop septicemia; predominantly involving gram positive cocci including MRSA and methicillin sensitive Staphylococcus aureus. Blood culture (BC) is the traditional detection method for septicemia. However, antibiotics and inadequate sample volumes can impair detection by BC and results can take 3-4 days. Polymerase chain reaction (PCR) represents a potential adjunct to BC. Pathogens are detected in a growth-independent manner by targeting their genetic make-up. Quantitative determining of pathogen DNA using PCR could aid in determining antimicrobial drug therapy efficacy by providing results on the same testing day as opposed to 3-4 days with BC. PCR may also detect persistent infections during antimicrobial therapy when culture samples are inhibited. The aims of this study are:(1)to correlate quantitative PCR results with that of the BC; (2) to test the clinical application of PCR results with clinical outcomes of treatment of presumptive diagnosis of staphylococcal sepsis.

Official Title
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Rapid, Quantitative, PCR-Based Detection Of Staphylococcus Aureus in Burn Sepsis Patients

Conditions
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Burns, Sepsis

Intervention / Treatment
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* Other: PCR test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 20% or > TBSA burns at hospital admission will require BC during hospital stay Patient/surrogate able to sign consent Exclusion Criteria: allergic to nafcillin, cefazolin, vancomycin, linezolid, and/or daptomycin on antibiotic(s) prior to first BC

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: No PCR testing<br>Control patients will not have PCR testing. This group will have routine testing and treatment as defined by the standard of care. | |
| Experimental: PCR testing<br>PCR will be used in parallel with routine laboratory tests such as culture. Treatment for PCR results will be based on the standard of care. Treatment of the patient will be dependent on the physician's clinical judgment based on existing clinical information including PCR, microbiology, patient physical presentation, and other laboratory results. | Other: PCR test<br>* PCR samples will test for Staphylococcus aureus (including MRSA) from wound swab and positive blood culture samples to augment treatment decisions. Serial PCR testing will follow after positive results to catalog pathogen loads over the course of treatment in a blinded fashion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation of PCR results with blood culture results |  | 72 hours after positive blood culture results | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of signs of infection |  | 14 days after the administrationof anti-Staphylococcus therapy | 
| Duration of antibiotic use |  | 14 days after administration of antimicrobial therapy | 
| Correlation of PCR result with mortality |  | Day 28 of intensive care unit stay | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Burn, Sepsis, Infection