• Canadian Critical Care Trials Group
    The Canadian Critical Care Trials Group (CCCTG) is a highly collegial group that is dedicated to the pursuit of excellence and advancement of critical care research in Canada.
  • Canadian Critical Care Trials Group
    The CCCTG has are more than 30 research programs underway and over 100 peer-reviewed publications to its credit, with direct impact on clinical practice in critical care.
  • Canadian Critical Care Trials Group
    The Canadian Critical Care Trials Group (CCCTG) is a national organization of more than 300 individuals with research interests in the management of the critically ill patient.
  • Canadian Critical Care Trials Group
    Endorsement by the CCCTG communicates our full commitment to ensure that the work is undertaken in a rigorous and ethical manner, and communicated in a timely and effective way.
Programs

Principal Investigator(s)

Coordinator(s)

A Rishu

Status

Completed

BALANCE — Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness

The BALANCE research program focuses on optimizing antibiotic treatment duration in critically ill patients with bloodstream infections. The aim of this research program is to determine whether shorter duration antimicrobial therapy is associated with non-inferior mortality compared with longer duration antimicrobial therapy. Thus far we have completed: With broad collaboration within the Canadian Critical Care Trials Group (CCCTG), and funding from the Canadian Institutes of Health Research (CIHR), we are starting the BALANCE main trial at sites across Canada, most of which participated in the pilot trial, in addition to collaborating with international partners. For more information, please visit http://balance.ccctg.ca 
  • Primary Research Question for the BALANCE RCT
Is 7 days of antibiotics non-inferior to 14 days of antibiotics for preventing death among critically ill patients with blood stream infections.
 
Highlights: Our BALANCE pilot RCT is complete.  90-day outcome and all data entry is complete for pilot patients (n= 115) and full analyses are to be completed soon.
  • The BALANCE main RCT has received funding of $2 million from CIHR for the next 5 years
BALANCE Publications to date:
1. Antimicrobial Cost Savings Associated with Shorter Duration Treatment for Bloodstream Infections. JAMMI 2016;1(2): 99-100.
2. Pathogens and antimicrobial susceptibility patterns in Canadian critically ill patients with bloodstream infections: a descriptive study. CMAJ Open 4:E569-E577; published online October 13, 2016
3. The effect of inadequate initial empiric antimicrobial treatment on mortality in critically ill patients with bloodstream infections: A Multi-Centre Retrospective Cohort Study. PLoS One 2016;11(5).
4. Duration of Antimicrobial Treatment for Bacteremia in Canadian Critically Ill Patients. Crit Care Med 2016;44(2):256-64.
5. Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE): study protocol for a pilot randomized controlled trial. Trials 2015;16:173.
6. Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis. Crit Care. 2011;15 (6):R267.
7. Antibiotic Treatment Duration for Bloodstream Infections in Critically Ill Patients: A National Survey of Canadian Infectious Diseases and Critical Care Specialists. Int J Antimicrob Agents 2011;38:480-5.
8. Duration of Antibiotic Therapy in Intensive Care Unit Bloodstream Infections. Can J Infect Dis Med Microbiol 2013;24(3):129-37.

BALANCE Abstracts Presented to date:
1. Duration of antimicrobial therapy for bloodstream infections critically ill patients in the United Kingdom. The Intensive Care Society - State of the Art Meeting, Dec 2015, London, UK
2. The effect of inadequate initial antimicrobial treatment on mortality in critically ill patients with bloodstream infections. Infectious Diseases Society of America (IDSA) IDWeek. 2015, San Diego, USA.
3. Patient And Pathogen Predictors Of Antibiotic Treatment Duration For Bloodstream Infection In Critically Ill Patients. American Thoracic Society. 2014, San Diego, USA.
4. Measuring The Duration Of Adequate Antimicrobial Treatment For Blood Stream Infections In Critically Ill Patients. American Thoracic Society. 2014, San Diego, USA.
5. Description Of Duration Of Treatment For Bloodstream Infection In Critically Ill Patients: A Multi-Centre Observational Study. American Thoracic Society. 2014, San Diego, USA.
6. Determining The Inter-Reviewers' Reliability In Documenting Potential Source And Relapse Of Underlying Source In Critically Ill Bacteremic Patients. American Thoracic Society. 2014, San Diego, USA.
7. Patient and Pathogen Predictors of Antibiotic Treatment Duration for Bloodstream Infection in Critically Ill Patients. Canadian Critical Care Forum. Toronto. 2013.
8. Measuring the Duration of Adequate Antimicrobial Treatment in Critical Care. Canadian Critical Care Forum. Toronto. 2013.
9. Description of Treatment Duration for Bloodstream Infections: A Multi-Centre Observational Study. Canadian Critical Care Forum. Toronto. 2013.

Contact
Rob Fowler

Co-Investigators

Nick Daneman, Robert Fowler, John Marshall, Michael Detsky, Elizabeth Wilcox, Deborah Cook, Bram Rochwerg, Richard Whitlock, Emilie Belley-Côté, Claudio Martin, John Muscedere, Lauralyn McIntyre, Francois Lamontagne, Francois Lauzier, Pierre Aslanian, Emmanuel Charbonney, Anand Kumar, Henry T. Stelfox, Sean Bagshaw, Steve Reynolds, Peter Dodek, Richard Hall

International collaborators
Australia and New Zealand – S. Webb, Y. Shehabi, S. McGuinness, C. McArthur, Rachael Parke,
France – E. Azoulay, A. Mercat
Germany – F. Bloos
Kingdom of Saudi Arabia – Y. Arabi, B. Alraddadi,  I. Qushmaq, E. Alqasim, M. Al-Wassia
Switzerland – P. Eggimann, J.L. Pagani, L. Guihard
United Kingdom – T. Walsh, J. Simpson, P. Dark, T. Hellyer, M. Gillies, F. Julie, K. L. Bedwell, T. Evans
United States – The USCIIT group

Participating Centers

Sunnybrook Hospital, St. Michael's Hospital, Mount Sinai Hospital, Toronto Western Hospital, St. Joseph's Healthcare, Juravinski Hospital, McMaster University, London Health Sciences Centre, Kingston General Hospital, The Ottawa Hospital, Centre de recherche du CHUS, Centre de recherche du CHU de Québec, Centre hospitalier de l'université de Montréal (CHUM), CSSS of Trois-Rivières, Hôpital du, Sacré-Coeur de Montréal (HSCM), Winnipeg Regional Health, Foothills hospital, University of Calgary, University of Alberta Hospital, Royal Columbian Hospital, St. Paul's Hospital, Queen Elizabeth II