Clindamycin as an Alternative to Vancomycin in Patients Undergoing Aortic Cardiac Surgery With Extracorporeal Circulation (ECC) (CLINDAPASS)

Nantes University Hospital (NUH)

Status and phase

Begins enrollment in 1 month

Phase 2

Conditions

Aortic Surgery

Extracorporeal Circulation

Treatments

Drug: Clindamycin

Study type

Interventional

Funder types

Other

Identifiers

NCT07267013

RC24_0549

2025-521555-23-00 (EU Trial (CTIS) Number)

Details and patient eligibility

About

Antibiotic prophylaxis is essential for all types of cardiac surgery under Extracorporeal Circulation (ECC), in order to reduce the incidence of surgical site infection (SSI). However, many patients are allergic to beta-lactam antibiotics. All the more, vancomycin antibiotic recommended as replacement is not without adverse effects and frequently administered in an inappropriate manner in terms of pre-intervention timing, linked to its complex use on peripheral venous lines complicated by venotoxicity. Non-compliance with the correct use of antibiotic prophylaxis in surgery is responsible for nosocomial infections, which have an impact on both the patient and the healthcare establishment in terms of costs, particularly in cardiac surgery.

Drug pharmacokinetics are more complex under bypass surgery (high volume of distribution), and studies are needed to determine the correct administration and diffusion of drugs.

In this respect, clindamycin is an antibiotic already used in antibiotic prophylaxis for other surgeries (thoracic, orthopedic...) in cases of allergy to beta-lactam antibiotics, but to date there are no studies examining the pharmacokinetics of this molecule in the context of cardiac surgery under ECC.

The aim of this protocol is to demonstrate the feasibility of using clindamycin in patients undergoing ECC surgery, by verifying that the plasma concentration of clindamycin exceeds the minimum inhibition concentration (MIC) of the main bacteria involved in mediastinitis throughout the surgical procedure.

Full description

ECC is indispensable for cardiac surgery, but this assistance modifies the pharmacological properties of drugs, with a particular increase in the volume of distribution of antibiotics such as clindamycin. All these factors lead to an increase in the dosage of certain drugs and more frequent injections.

Robust data on percutaneous clindamycin treatment would therefore enable to improve the management of this type of patient, with real impact.

There are currently no pharmacological studies justifying the use of clindamycin to combat nosocomial infections in cardiac surgery, despite the fact that its anti-bacterial spectrum is identical to that of the antibiotics currently used in patients (methicillin-sensitive Staphylococcus aureus (MSSA)).

Clindamycin is simpler to use and does not induce venotoxicity. The fact that the patient is undergoing bypass surgery means that pharmacokinetic studies can be carried out with several blood samples taken from the arterial pressure catheter routinely inserted in all surgical patients, in order to limit the volume of blood taken and avoid any discomfort for the patient. This would make it possible to check the plasma stability of this antibiotic over several periods, with reinjections if necessary (if surgery > 4h).

The hypotheses are that clindamycin (i) is simple to use, (ii) has correct and stable diffusion kinetics in patients undergoing scheduled cardiac surgery with ECC (iii) is well tolerated by patients (iv) has an estimated free plasma concentration above the epidemiological threshold Minimal Inhibition Concentration (MIC) of Staphylococcus aureus and therefore provides sufficient protection against SSI.

Enrollment

25 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Adult ≥ 18 years of age,
Cardiac surgery under ECC
Surgery scheduled in the morning (added to the schedule at least 24 hours before the operation and starting at 8 a.m. in order to send blood tests during working hours).
Written, informed consent from the patient before the start of the protocol.
The patient must understand spoken and written French
Negative pregnancy test and effective contraception (according to CTFG recommendations) during treatment for women of childbearing age
Men of reproductive age using effective contraception (according to CTFG recommendations) during treatment
Social security affiliation
Patient able to understand the objectives of the study and comply with the requirements of the protocol

Exclusion criteria

Known hypersensitivity/allergy to clindamycin, lincomycin, and any other excipient listed in the SmPC
Known hypersensitivity/allergy to penicillins/drugs of the beta-lactam family
Patient on antibiotics other than cefazolin prior to surgery
Patient already on clindamycin at inclusion,
BMI>35
Aortic arch surgery
Coronary artery bypass graft surgery
Surgery for suspected endocarditis
Patients with chronic renal failure with creatinine clearance < 60 mL/min and/or undergoing chronic dialysis
Patients with hepatic insufficiency (prothrombin rate<50% excluding anticoagulant therapy) or Child B and C cirrhosis
Immunosuppressed patients receiving triple antiviral therapy
Pregnant or breast-feeding women
Women or men of childbearing age without effective contraception
Serious, uncontrolled concomitant bacterial infections (e.g. septic shock)
Patients deprived of their liberty by judicial or administrative decision (guardianship, curatorship, safeguard of justice)
Patient not registered with social security
Participation in any other therapeutic study with an exclusion period still in effect at the time of inclusion, or planned participation in another therapeutic study while taking clindamycin
Contraindications to cefazolin or any of the ancillary treatments
Mental state rendering the patient incapable of understanding the entire study
Patient being the investigator or any other member of the research team or being a relative of the investigator directly involved in the trial, including assistant physicians, pharmacists, nurses, and study coordinators