RT Journal Article
T1 Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due to Enterobacteriaceae (SIMPLIFY): a study protocol for a multicentre, open-label, phase III randomised, controlled, non-inferiority clinical trial.
A1 Lopez-Cortes, Luis Eduardo
A1 Rosso-Fernandez, Clara
A1 Nuñez-Nuñez, Maria
A1 Lavin-Alconero, Lucia
A1 Bravo-Ferrer, Jose
A1 Barriga, Angel
A1 Delgado, Mercedes
A1 Lupion, Carmen
A1 Retamar, Pilar
A1 Rodriguez-Baño, Jesus
K1 Enterobacteriaceae
K1 De-escalation
K1 antimicrobial stewardship
K1 bloodstream infection
K1 broad-spectrum antibiotics
AB Within the context of antimicrobial stewardship programmes, de-escalation of antimicrobial therapy is one of the proposed strategies for reducing the unnecessary use of broad-spectrum antibiotics (BSA). The empirical treatment of nosocomial and some healthcare-associated bloodstream infections (BSI) frequently includes a beta-lactam with antipseudomonal activity as monotherapy or in combination with other drugs, so there is a great opportunity to optimise the empirical therapy based on microbiological data. De-escalation is assumed as standard of care for experts in infectious diseases. However, it is less frequent than it would desirable. The SIMPLIFY trial is a multicentre, open-label, non-inferiority phase III randomised controlled clinical trial, designed as a pragmatic 'real-practice' trial. The aim of this trial is to demonstrate the non-inferiority of de-escalation from an empirical beta-lactam with antipseudomonal activity to a targeted narrow-spectrum antimicrobial in patients with BSI due to Enterobacteriaceae. The primary outcome is clinical cure, which will be assessed at the test of cure visit. It will be conducted at 19 Spanish public and university hospitals. Each participating centre has obtained the approval of the ethics review committee, the agreement of the directors of the institutions and authorisation from the Spanish Regulatory Agency (Agencia Española del Medicamento y Productos Sanitarios). Data will be presented at international conferences and published in peer-reviewed journals. Strategies to reduce the use of BSA should be a priority. Most of the studies that support de-escalation are observational, retrospective and heterogeneous. A recent Cochrane review stated that well-designed clinical trials should be conducted to assess the safety and efficacy of de-escalation. 
PB BMJ Group
YR 2017
FD 2017-06-09
LK http://hdl.handle.net/10668/11292
UL http://hdl.handle.net/10668/11292
LA en
NO López-Cortés LE, Rosso-Fernández C, Núñez-Núñez M, Lavín-Alconero L, Bravo-Ferrer J, Barriga Á, et al. Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due to Enterobacteriaceae (SIMPLIFY): a study protocol for a multicentre, open-label, phase III randomised, controlled, non-inferiority clinical trial. BMJ Open. 2017 Jun 9;7(6):e015439
DS RISalud
RD Aug 31, 2025