Exposure to NSAIDs (Non Steroidal Anti-Inflammatory Drugs) and Severity of Community-acquired Bacterial Infections

Overview

– NSAIDs are widely consumed, and some are currently available for self-medication with indications 'Pain and Fever' (Cavalié, National Agency for Drug Safety (ANSM), 2014) – There is no recommendation to limit their use in bacterial infections except for chicken pox in children. – To date, no study has highlighted the aggravating role of exposure to NSAIDs on bacterial infections in adults, based on the usual septic severity Levy's score (SSS), and mortality, but it delays adequate antibiotics (Legras, Critical Care, 2009) – Community-acquired bacterial infections in adults exposed to NSAIDs are serious by their spread (multiple locations), and suppurative character requiring frequent use of invasive procedures such as surgery or drainage. The SSS does not reflect the seriousness of these infections. They are frequently associated with use of ibuprofen (63.4%), and self-medication practices (65.5%). The main hypothesis is that NSAIDs exposure is associated with a specific severity of community-acquired bacterial infection, marked by dissemination, suppurative complications or even invasive procedures requirement. Our objectives are also to: – Describe what NSAID use terms are associated to the risk of serious bacterial infections: molecule, dosage, duration of exposure, access (prescription or self-medication), associated drugs. – To determine what type (s) (s) of bacterial infection is worsened by exposure to NSAIDs. – To determine if other risk factors contribute to severity of bacterial community acquired infection – To describe hospital costs associated to such severity of bacterial infection

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: April 10, 2018

Arms, Groups and Cohorts

  • patient
    • Adult patient hospitalized in MCO in one of the study centers for severe community bacterial infection, infected with more than one site, and / or abscess collection, and / or a per-cutaneous drainage of the infection, and / or septic surgery.
  • control
    • Patient hospitalized in the same center (different service or not), during the week or months of the inclusion of cases for infection without abscess or invasive procedure, only one infected site

Clinical Trial Outcome Measures

Primary Measures

  • exposure to NSAIDs
    • Time Frame: From the inclusion (J0) to the the end of hospital stay, up to three months
    • The risk studied is the exposure to NSAIDs, the overall medication history will be collected for cases and controls. The standard questionnaire to document medications history, including self-medication, was previously published (Asseray et al., 2013) The window of exposure to drugs is defined as 14 days before hospital admission. Drug exposure will be assessed at the time of inclusion.

Secondary Measures

  • Name of NSAIDS
    • Time Frame: 36 months
    • Describe what NSAIDs terms of use contribute to the risk of serious bacterial infections
  • type of bacterial infection at risk of worsening when exposed to NSAIDs
    • Time Frame: 36 months
    • Describe what type of bacterial infection is at risk of worsening when exposed to NSAIDs.
  • other drugs exposure assessed by questionnaire
    • Time Frame: 36 months
  • Duration of NSAID exposure
    • Time Frame: 36 months
  • self-medication assessment
    • Time Frame: 36 months

Participating in This Clinical Trial

Inclusion Criteria

  • Patient : adult patient hospitalized in managed care organization (MCO) in one of the study centers for severe community bacterial infection, infected with more than one site, and / or abscess collection, and / or a per-cutaneous drainage of the infection, and / or septic surgery – Control: Patient hospitalized in the same center (different service or not), during the week or months of the inclusion of cases for infection without abscess or invasive procedure, only one infected site Exclusion Criteria:

  • Hematologic or solid neoplasia undergoing chemotherapy, long-term corticosteroid, chronic exposure to NSAIDs, ongoing treatment with methotrexate or monoclonal antibody (anti-tumor necrosis factor (ant-TNF) particular), chronic buffy neutropenia, surgical site infections, catheter infections, disorders of consciousness or cognitive neuro-against-indicating the administration of the drug exposure questionnaire adults under guardianship, minor, no insurance disease, patients already included in a biomedical research with taking medication blind.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Nantes University Hospital
  • Collaborator
    • University Hospital, Tours
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Olivier Epaulard, PU-PH, Principal Investigator, University Hospital, Grenoble
    • Eric DENES, PH, Principal Investigator, University Hospital, Limoges
    • Thomas Guimard, PH, Principal Investigator, LA ROCHE SUR YON HOSPITAL
    • Louis BENARD, PU-PH, Principal Investigator, Tours University Hospital
    • Thierry MAY, PU-PH, Principal Investigator, Central Hospital, Nancy, France
    • Annie-Pierre JONVILLE-BERA, PH, Principal Investigator, Tours University Hospital

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