Clinical trial NCT03198819: Powder Topical Rifampicin on Reducing Infections After Neural Tube Defect Surgery in Infants
Official title: Powder Topical Rifampicin on Reducing Infections After Neural Tube Defect Surgery in Infants
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Postoperative Infection Rates
Keywords: Topical rifampicin, neural tube defects, infection, newborn
Lead sponsor: Yuzuncu Yıl University
Sponsor class: OTHER
First posted: 2017-06-26
Enrollment: 30
Sex: ALL
Minimum age (years): 1
Maximum age (years): 28
Standard ages: CHILD
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The study will be conducted in the Yuzuncu Yil University neonatal intensive care unit, Van, Turkey. The data of 60 neonates diagnosed with open NTD, who will be underwent surgical intervention between August 2016 and December 2017, will be prospectively evaluated. These cases will be randomised.These neonates are going to divide into two groups: the experimental group and the control group. The experimental group will be consisted of 30 newborns diagnosed with open NTDs, administered topical RIF (10 mg/kg/day, 24 h infusion) and cefotaxime (50 mg/kg/day, two doses, iv), and the control group will be consisted of 30 newborns diagnosed with open NTDs, administered cefotaxime (50 mg/kg/day, two doses).

Brief summary: The correct timing and technique of neural tube defect (NTD) repairs significantly decreases the morbidity and mortality of NTD cases. However, infections related to the surgery are still common. We investigated the effects of topical rifampicin (RIF) combined with routine prophylaxis in newborns with open NTD.

Detailed description: The study will be conducted in the Yuzuncu Yil University neonatal intensive care unit, Van, Turkey. The data of 60 neonates diagnosed with open NTD, who will be underwent surgical intervention between August 2016 and December 2017, will be prospectively evaluated. These cases will be randomised.These neonates are going to divide into two groups: the experimental group and the control group. The experimental group will be consisted of 30 newborns diagnosed with open NTDs, administered topical RIF (10 mg/kg/day, 24 h infusion) and cefotaxime (50 mg/kg/day, two doses, iv), and the control group will be consisted of 30 newborns diagnosed with open NTDs, administered cefotaxime (50 mg/kg/day, two doses).

In this study, researchers will be investigated whether prophylactic topical RIF applied on a pre-operative mesh in newborns with open NTD reduce the rate of SSIs and meningitis/ VP shunt infections after surgery. For deep incisional primary SSIs will be evaluated according to the diagnostic criteria of the United States (U.S.) Centers for Disease Control and Prevention (CDC) (1). The diagnosis of VP shunt infections will be made after extensive clinical and laboratory evaluations. the diagnosis of to make shunt infections, criteria of the Hydrocephalus Clinical Research Network (HCRN) will be taken into consideration (2).

Topical RIF Application Procedure The NTD site will be covered with a sterile gauze dressing in the first hours of life after birth in all babies with open NTDs. Then, 10 mg/kg/day RIF will be added to 24 ml of saline (0,9% NaCl), and this will be applied to the mesh as an infusion at a 1cc/h speed . Every day, the same dose of RIF will be delivered to the mesh,changed daily, as a 24-hour infusion until the patient could be operated. After the patient is operated, the RIF infusion delivered to the mesh will be stopped. The cefotaxime treatment will be continued until 72 hours post-op (3).

Eligibility criteria: Inclusion Criteria:

* Newborns who have open NTDs

Exclusion Criteria:

* Healthy newborns

Primary outcomes:
measure: Surgical site infections
timeFrame: within 30 days
measure: The diagnosis of ventriculoperitoneal (VP) shunt infection
timeFrame: within one month
Secondary outcomes:
measure: Length of hospitalization
timeFrame: within 6 months
Other outcomes:
Locations:
city: Van
country: Turkey
facility: Yuzuncu yil medical school
state: Outside of the US
Study officials:
affiliation: yüzüncüyıl üniversitesi
name: nihat demir
role: STUDY_DIRECTOR
References:
citation: Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988 Jun;16(3):128-40. doi: 10.1016/0196-6553(88)90053-3.
citation: Beckman JM, Amankwah EK, Tetreault LL, Tuite GF. Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure. J Neurosurg Pediatr. 2015 Dec;16(6):648-61. doi: 10.3171/2014.12.PEDS13675. Epub 2015 Sep 18.
citation: Demir N, Peker E, Gulsen I, Kocaman S, Tuncer O, Kirimi E. Powder Topical Rifampin for Reducing Infections After Neural Tube Defect Surgery in Infants. World Neurosurg. 2016 Nov;95:165-170. doi: 10.1016/j.wneu.2016.07.092. Epub 2016 Aug 6.