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Trial registered on ANZCTR
Registration number
ACTRN12624000266561
Ethics application status
Approved
Date submitted
16/02/2024
Date registered
15/03/2024
Date last updated
7/04/2024
Date data sharing statement initially provided
15/03/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Pilot trial assessing antibiotic duration in diabetic foot ulcers that probe to bone
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Scientific title
Pilot randomised controlled trial of feasibility and safety in probe-to-bone diabetic foot ulcer antibiotic therapy
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Secondary ID [1]
310887
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PROBE-DFU trial
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Universal Trial Number (UTN)
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Trial acronym
PROBE-DFU trial
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
diabetic foot ulcer
331940
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Condition category
Condition code
Infection
328666
328666
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0
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Studies of infection and infectious agents
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Metabolic and Endocrine
328667
328667
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0
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Diabetes
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Probe-to-bone test procedure
-Bedside clinical test performed by inserting a blunt metal probe into an ulcer and palpating for bone at the base
-This test will be performed by a trained clinician (podiatrist or experienced doctor) at initial assessment
-Antibiotic therapy will be commenced as soon as possible after a positive result (ideally on the same day)
Intervention group: 2 weeks antibiotic therapy
-Antibiotic therapy, including agent, dosing and route of administration, will be at the discretion of the treating clinicians based on results of any relevant microbiological culture and susceptibility results, such as wound swab cultures.
-Common antibiotic regimens likely to be used will include oral glucloxacillin 500mg QID, oral Amoxicillin/clavulanate 800/125mg BD, oral Clindamycin 450mg TDS, etc
-Adherence will be assessed via a medication adherence questionnaire given to the patient at each follow-up visit. This questionnaire is specifically designed for this study by the investigators
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Intervention code [1]
327310
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Treatment: Drugs
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Comparator / control treatment
Control group: 6 weeks antibiotic therapy
-Antibiotic therapy, including agent, dosing and route of administration, will be at the discretion of the treating clinicians based on results of any relevant microbiological culture and susceptibility results, such as wound swab cultures.
-Common antibiotic regimens likely to be used will include oral glucloxacillin 500mg QID, oral Amoxicillin/clavulanate 800/125mg BD, oral Clindamycin 450mg TDS, etc
-Adherence will be assessed via a medication adherence questionnaire given to the patient at each follow-up visit. This questionnaire is specifically designed for this study by the investigators.
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Control group
Active
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Outcomes
Primary outcome [1]
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Eligibility to recruitment ratio
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Assessment method [1]
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Number of patients screened to number of patients recruited
-Collected via an audit of screening log
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Timepoint [1]
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End of recruitment period (18 months)
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Primary outcome [2]
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Retention rate
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Assessment method [2]
336465
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Proportion of recruited participants that complete the treatment and follow up
-Collected via audit of study records in data collection instrument (REDCap)
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Timepoint [2]
336465
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End of recruitment period (18 months)
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Primary outcome [3]
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Adherence to protocol
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Assessment method [3]
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Proportion of recruited participants that adhered to protocol till completion
-Collected via audit of study records in data collection instrument (REDCap)
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Timepoint [3]
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End of recruitment period (18 months)
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Secondary outcome [1]
428486
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Recommencement of antibiotic therapy
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Assessment method [1]
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Recurrence of infection at same or contiguous site, diagnosed clinically or radiologically requiring administration of multiple (>1) doses of antibiotic therapy within the follow-up period
-Assessed at each follow-up visit via patient interview and audit of electronic medical records
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Timepoint [1]
428486
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90 days post-initial baseline assessment
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Secondary outcome [2]
428487
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Need for surgical management
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Assessment method [2]
428487
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Recurrence or persistence of infection at same or contiguous site requiring surgical debridement/amputation within the follow-up period
-Assessed at each follow-up visit via patient interview and audit of electronic medical records
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Timepoint [2]
428487
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90 days post-initial baseline assessment
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Secondary outcome [3]
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Continuation of antibiotics
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Assessment method [3]
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Persistence of infection at same site requiring continuation of antibiotics beyond the planned duration
-Determined by treating clinician following clinical assessment at follow-up visits
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Timepoint [3]
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14 days, 42 days, 90 days post-initial baseline assessment
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Secondary outcome [4]
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Radiological changes
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Assessment method [4]
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Development of new X-ray changes of osteomyelitis
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Timepoint [4]
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Day 14, Day 42 post-initial baseline assessment
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Eligibility
Key inclusion criteria
-Adult patient (greater than or equal to 18 years) with diabetic foot ulcer
-Ulcer with positive probe-to-bone test
-X-ray performed within 72 hours of enrollment demonstrating no changes suggestive of osteomyelitis at the site of the ulcer by the reporting radiologist
-Willing and able to consent
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
-Systemic antimicrobial therapy for >7 days in the 30 days prior to initial enrollment
-Systemic signs of sepsis based on SIRS criteria
-Initial surgical therapy deemed more appropriate than medical management alone of diabetic foot infection
-Known pregnancy
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Central randomisation via REDCap
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
18/03/2024
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Actual
21/03/2024
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Date of last participant enrolment
Anticipated
18/10/2025
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Actual
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Date of last data collection
Anticipated
18/01/2026
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Actual
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Sample size
Target
120
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Accrual to date
2
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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Department of Infectious Diseases and Immunology, Austin Health
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Address [1]
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Country [1]
315145
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Australia
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Primary sponsor type
Hospital
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Name
Austin Health
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Address
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Country
Australia
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Secondary sponsor category [1]
318108
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None
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Name [1]
318108
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Address [1]
318108
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Country [1]
318108
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314083
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Austin Health Human Research Ethics Committee
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Ethics committee address [1]
314083
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https://www.austin.org.au/Office-for-Research/
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Ethics committee country [1]
314083
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Australia
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Date submitted for ethics approval [1]
314083
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11/12/2023
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Approval date [1]
314083
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15/02/2024
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Ethics approval number [1]
314083
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Summary
Brief summary
Probe-to-bone test (PTB) is a simple bedside clinical test to aid in the diagnosis of diabetic foot osteomyelitis (OM). While it has been shown to be useful (especially in a high-risk cohort), diagnosis of OM is supported by additional tests such as X-rays and blood tests for markers of infection. The gold standard test for diagnosing OM is a bone biopsy, which is often not routinely performed due to the invasiveness of the procedure and the difficulty with accessing clinicians trained in performing this. Patients with diabetic foot ulcers and positive PTB tests are often treated for OM with prolonged courses of antibiotics despite normal X-rays and/or normal biomarkers of infection. This study aims to evaluate the safety and feasibility of treating patients with diabetic foot ulcers and positive PTB test with shorter courses of antibiotic therapy in a low-risk (outpatient) setting.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Jason Trubiano
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Address
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Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria - 3084
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Country
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Australia
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Phone
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+61 3 94966676
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
130351
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Satwik Motaganahalli
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Address
130351
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Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria - 3084
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Country
130351
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Australia
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Phone
130351
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+61 3 94964573
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Fax
130351
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Email
130351
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[email protected]
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Contact person for scientific queries
Name
130352
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Satwik Motaganahalli
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Address
130352
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Department of Infectious Diseases, Austin Health, 145 Studley Road, Heidelberg, Victoria - 3084
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Country
130352
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Australia
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Phone
130352
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+61 3 94964573
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Fax
130352
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Email
130352
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Doc. No.
Type
Citation
Link
Email
Other Details
Attachment
21667
Study protocol
[email protected]
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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