Hematologic Diseases Clinical Trial
Official title:
Randomized Double Blind Controlled Trial for the Treatment of Nucleic Acid Amplification Test (NAAT)+/Toxin Enzyme Immunoassay (EIA)- Clostridium Difficile in the Hematology Oncology Population
Verified date | July 2020 |
Source | Medical College of Wisconsin |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study will randomized hematology oncology patients with active diarrhea and a NAAT
positive/toxin EIA negative to either 14 days of oral vancomycin capsules or placebo. The
study is designed to include 30 patients (15 per arm).
Outcomes will include C. difficile load using qPCR, VRE loads, structural and functional
microbiome changes and frequency of bowel movements. All endpoints will be measured at
several time points including days 0, 14, 21 and 90.
Status | Completed |
Enrollment | 9 |
Est. completion date | June 30, 2020 |
Est. primary completion date | June 30, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Patients admitted to the hematology oncology inpatient units at Froedtert Memorial Lutheran Hospital - New onset of diarrhea during hospitalization - C. difficile clinical testing showing NAAT positive EIA negative results Exclusion Criteria: - Being unable to consent for self - Inability to take enteral medications - Unwillingness to enroll in study - Patient has a documented allergy to vancomycin - Patient has a documented life expectancy shorter than treatment course (14 days) - Patient is unwilling or unable to provide stool samples in the outpatient setting after discharge - Diagnosis of C. difficile colitis [NAAT (+) and toxin EIA (+) within 3 months of enrollment). - New onset of abdominal distention within 24 hours prior to the onset of diarrhea during index admission - Presence of toxic megacolon - Presence of clinical sepsis. Sepsis will be defined as a Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more as per 2016 definitions - Pregnancy or lactating |
Country | Name | City | State |
---|---|---|---|
United States | Froedtert and the Medical College of Wisconsin | Milwaukee | Wisconsin |
Lead Sponsor | Collaborator |
---|---|
Medical College of Wisconsin |
United States,
Aldrete SD, Kraft CS, Magee MJ, Chan A, Hutcherson D, Langston AA, Greenwell BI, Burd EM, Friedman-Moraco R. Risk factors and epidemiology of Clostridium difficile infection in hematopoietic stem cell transplant recipients during the peritransplant period — View Citation
Isaac S, Scher JU, Djukovic A, Jiménez N, Littman DR, Abramson SB, Pamer EG, Ubeda C. Short- and long-term effects of oral vancomycin on the human intestinal microbiota. J Antimicrob Chemother. 2017 Jan;72(1):128-136. Epub 2016 Oct 5. — View Citation
Lessa FC, Winston LG, McDonald LC; Emerging Infections Program C. difficile Surveillance Team. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015 Jun 11;372(24):2369-70. doi: 10.1056/NEJMc1505190. — View Citation
Martin JS, Monaghan TM, Wilcox MH. Clostridium difficile infection: epidemiology, diagnosis and understanding transmission. Nat Rev Gastroenterol Hepatol. 2016 Apr;13(4):206-16. doi: 10.1038/nrgastro.2016.25. Epub 2016 Mar 9. Review. — View Citation
Polage CR, Gyorke CE, Kennedy MA, Leslie JL, Chin DL, Wang S, Nguyen HH, Huang B, Tang YW, Lee LW, Kim K, Taylor S, Romano PS, Panacek EA, Goodell PB, Solnick JV, Cohen SH. Overdiagnosis of Clostridium difficile Infection in the Molecular Test Era. JAMA I — View Citation
Sethi AK, Al-Nassir WN, Nerandzic MM, Bobulsky GS, Donskey CJ. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol. 2010 Jan;31(1):21-7. doi: 10.1086/649016. — View Citation
Theriot CM, Bowman AA, Young VB. Antibiotic-Induced Alterations of the Gut Microbiota Alter Secondary Bile Acid Production and Allow for Clostridium difficile Spore Germination and Outgrowth in the Large Intestine. mSphere. 2016 Jan 6;1(1). pii: e00045-15. doi: 10.1128/mSphere.00045-15. eCollection 2016 Jan-Feb. — View Citation
Theriot CM, Koenigsknecht MJ, Carlson PE Jr, Hatton GE, Nelson AM, Li B, Huffnagle GB, Z Li J, Young VB. Antibiotic-induced shifts in the mouse gut microbiome and metabolome increase susceptibility to Clostridium difficile infection. Nat Commun. 2014;5:3114. doi: 10.1038/ncomms4114. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Changes in Clostridium difficile bacterial loads in the stool | Changes in Clostridium difficile bacterial counts from stool as determined by quantitative polymerase chain reaction (PCR) | Pre-treatment, 1, 7, 14, 21, 28, and 90 days past the beginning of treatment |
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