Excellent recruitment to Urgent Public Health study in Bristol
ADAPT Sepsis has recently been badged as an Urgent Public Health (UPH) study. The trial is a randomised controlled trial examining the role of biomarkers, in this case widely available blood tests, in antibiotic stewardship. This means looking at how antibiotics are used and trying to ensure we only use them for as long as really needed, reducing the risk of antibiotic resistance.
Participants in the trial are allocated to one of three groups:
- C-reactive protein (CRP) based decision support - this is an acute phase protein that increases in bacterial infections. It is a general measure of inflammation.
- Procalcitonin (PCT) based decision support - this is more specific for infection, in particular bacterial infection.
- Usual care.
Clinicians are blinded to the group allocation and receive advice each day the patient is on antibiotics. Tracking CRP and PCT and looking at how fast they fall can tell us if the infection is being treated adequately. Using these blood tests should help us get the length of antibiotic treatment right, which might improve outcomes for patients.
North Bristol NHS Trust have had excellent recruitment to the trial. Matt Thomas, Clinical Research Specialty Lead for Critical Care said:
“When people come to hospital with COVID-19 symptoms it can be difficult to tell if they have a bacterial infection or COVID-19. This means all patients have been getting antibiotics, and antibiotic use associated with COVID-19 has been massive. If the advice generated from the ADAPT Sepsis trial helps minimise unnecessary antibiotic use across the country it would be a good thing.
“At North Bristol NHS Trust, where we are running the trial, we have dedicated research nurses based in the intensive care unit who have a good working relationship with the clinical staff. I think this is the main reason why we have been so successful with recruitment at the site. We included a research report in the weekly ICU meeting and research nurses were excellent in communicating with clinical teams when patients were in the trial and in providing study advice.”
There is some evidence from other countries that biomarker (specifically PCT) guided antibiotic decision making can reduce antibiotic use and mortality. Whether this will be true in the NHS setting is the question ADAPT Sepsis is designed to answer.