GRam Stain-guided Antibiotics ChoicE for Ventilator-Associated Pneumonia (GRACE-VAP) Trial

Summary

Background: Optimising the use of antibiotic agents is a pressing challenge to overcoming the rapid emergence and spread of multidrug-resistant pathogens in intensive care units (ICUs). Although Gram staining may possibly provide immediate information for predicting pathogenic bacteria, Gram stain-guided initial antibiotic treatment is not well established in the ICU setting. The investigators planned the GRam stain-guided Antibiotics ChoicE for Ventilator-Associated Pneumonia (GRACE-VAP) trial to investigate whether Gram staining can safely restrict the use of broad-spectrum antibiotics in patients with ventilator-associated pneumonia (VAP), which is one of the most common hospital-acquired infections in ICUs.

Methods/Design: The GRACE-VAP trial is a multicenter, randomised, open-label parallel-group trial to assess the non-inferiority of Gram stain-guided initial antibiotic treatment to guidelines-based initial antibiotic treatment for the primary endpoint of clinical cure rate in patients with VAP. Secondary endpoints include the coverage rates of initial antibiotic therapies, the selected rates of anti-pseudomonal agents and anti-methicillin-resistant Staphylococcus aureus (MRSA) agents as initial antibiotic therapies, 28-day all-cause mortality, ICU-free days, ventilator-free days, and adverse events. Participants are randomly assigned to receive Gram stain-guided treatment or guidelines-based treatment at a ratio of 1:1. In the Gram stain group, results of Gram staining of endotracheal aspirate are used to guide the selection of antibiotics. In the guidelines group, the combination of an anti-pseudomonal agent and anti-MRSA agent are administered. A total sample size of 200 was estimated to provide a power of 80% with a 1-sided alpha level of 2.5% and a non-inferiority margin of 20%, considering 10% non-evaluable participants.

Discussion: The GRACE-VAP trial is expected reveal whether Gram staining can reduce the use of broad-spectrum antibiotics without impairing patient outcomes and thereby provide evidence for an antibiotics selection strategy in patients with VAP.

Conditions

• Ventilator Associated Pneumonia

Interventions

DRUG

Gram stain-guided antibiotic choice

The results of Gram staining of endotracheal aspirate are used to guide the selection of antibiotics.

DRUG

Guidelines-based antibiotics choice

Patients are administered the combination of an anti-pseudomonal agent and anti-MRSA agent according to IDSA/ATS guidelines

Sponsors & Collaborators

• Chukyo Hospital

  collaborator UNKNOWN

• Ebina General Hospital

  collaborator UNKNOWN

• Hitachi General Hospital

  collaborator UNKNOWN

• Kansai Medical University

  collaborator OTHER

• Kansai Medical University Medical Center

  collaborator UNKNOWN

• Nagasaki University

  collaborator OTHER

• Saga University

  collaborator OTHER

• University of the Ryukyus

  collaborator OTHER

• Wakayama Medical University

  collaborator OTHER

• Tajima Emergency and Critical Care Medical Center

  collaborator UNKNOWN

• Sapporo City General Hospital

  collaborator UNKNOWN

• Osaka General Medical Center

  lead OTHER

Principal Investigators

• Jumpei Yoshimura, MD · Osaka General Medical Center

• Kazuma Yamakawa, MD, PhD · Osaka General Medical Center

• Takeshi Morimoto, MD, PhD, MPH · Hyogo Medical University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

15 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-04-01

Primary Completion

2020-06-28

Completion

2020-06-28

FDA Drug

Yes

Countries

• Japan

Study Locations