Fecal Microbiota Transplantation for Carbapenem-resistant Enterobacteriaceae

Carbapenem-Resistant Enterobacteriaceae Infection Clinical Trial

Official title:

Fecal Microbiota Transplantation for Eradication of Carbapenem-resistant Enterobacteriaceae Colonization: Randomized Control Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04146337
• Other study ID #: 0338-19
• Status: Completed
• Phase: Phase 2/Phase 3
• Start date: October 12, 2020
• Est. completion date: June 30, 2022

Study information

• Verified date: November 2022
• Source: Rambam Health Care Campus
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

2:1, open-label, single center, randomized controlled trial comparing FMT vs. no intervention for CRE carriers,

Description:

Antibiotic resistance has emerged worldwide and is of major concern leading to multidrug resistant (MDR) bacteria that are widely spread and are a major factor in morbidity and mortality in health-care settings. Among MDRs, carbapenem resistant Enterobacteriaceae (CRE) are of special concern, receiving the highest classification of "urgent threat level" in the US President Report. Consistent mortality rates of 40-50% are observed among inpatients with infections caused by CRE in hospitals worldwide, related mainly to unavailable, delayed or ineffective antibiotic treatment options. The extremely high mortality rates of patients with CRE infections have driven efforts to prevent the acquisition and spread of these bacteria in hospitals. These include screening for carriage, contact isolation of carriers, cohorting, dedicated healthcare staff and other infection control measures. These strategies have been proven as effective but are cumbersome and expensive. In most locations these strategies failed to completely eradicate CRE endemicity. CRE decolonization (eradication of colonization) might offer a double benefit: reducing the risk for the individual carrier to develop an infection due to the resistant strain (by that, potentially lowering the mortality risk) and preventing the bacteria from spreading to other patients, exposing them to the same hazard. Fecal microbiota transplantation (FMT), in which fecal material enriched with commensal microorganisms is transferred from a healthy donor, have proven efficacy in the treatment of recurrent Clostridium difficile infection (CDI) in multiple trails. Major adverse events that has been reported so far are mostly related to the route of administration (aspiration during nasogastric tube administration/colonoscopy). Other adverse events include mostly GI related symptoms (diarrhea, nausea, belching) and are self limited and resolve in few hours. FMT seems to be safe and effective both in immunocompetent and immunocompromised patients. The high efficacy of FMT in the treatment of a multi-drug resistant pathogen such as Clostridium difficile, suggest that it might be an efficient tool for other MDR pathogens (e.g. CRE). The potential of FMT to restore the gut microbiome and compete with residual resistant strains offer a novel way to fight the current MDR epidemic.

The investigators aim to assess the effects of FMT on colonization and clinical infections with CRE. The investigators will apply FMT on a cohort of CRE carriers in a single center in Israel. FMT will be given by capsules for 2 consecutive days followed by rectal sampling at predefined time-point in the following 6 months.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 3
• Est. completion date: June 30, 2022
• Est. primary completion date: December 31, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 120 Years

Eligibility

We will include adult inpatients =18 years positive for CRE of any strain and resistance mechanism in rectal surveillance stool samples, with or without CRE clinical samples. We will mandate a positive rectal swab within one week before randomization. Several exclusion criteria may change throughout the patients' hospitalization and we will follow-up patients for these criteria until reaching eligibility or not (designed as (for follow-up)). Non-eligible patients discharged will be re-evaluated for inclusion when re-admitted.

We will exclude:

• Pregnant women

• Patients with severe neutropenia (<100/µl) (for follow-up)

• Severe GVHD involving the gastrointestinal involvment (for follow-up)

• Patients with inflammatory bowel disease (Crohn's or ulcerative colitis)

• Patients with intestinal perforation or severe abdominal infection (for follow-up)

• Patients carrying a colostomy, ileostomy or similar

• Inability or contra-indication to take oral medications (intestinal obstruction, suspected perforation, peritonitis) (for follow-up)

• Severe food allergies

• Severe diarrhea (for follow-up)

• Inability to provide informed consent (for follow-up)

• Refusal of primary care physician

• Patients treated with antibiotics within the 2 days before fulfilling all other eligibility criteria (for follow-up)

Related Conditions & MeSH terms

• Carbapenem-Resistant Enterobacteriaceae Infection
• Enterobacteriaceae Infections

Intervention

Biological:
• FMT
Fecal microbiota in frozen capsules

Locations

Country	Name	City	State
Israel	Rambam Health Care Campus	Haifa

Sponsors (1)

Lead Sponsor	Collaborator
Rambam Health Care Campus

Country where clinical trial is conducted

Israel, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	CRE eradication	Number of participants achieving CRE eradication at 28 days, defined as 3 consecutive negative rectal cultures, with polymerase chain reaction preformed in the last sample. For patients with clinical infections, eradication definition will include a negative culture from the site of infection, if relevant at the time of eradication.	28 days
Secondary	CRE eradication rates at day 7, day 14, and 3 & 6 months	Number of participants achieving CRE eradication rates at day 7, day 14, and 3 & 6 months	days 7, 14, months 3, 6
Secondary	Mortality	Number of participants who died by 28-day and 6 month	28-day and 6 months
Secondary	Bacteremia	Number of participants with CRE bacteremia and any bacteremia	6 months
Secondary	CRE infection	Number of participants with non-bacteremic new clinically-significant CRE infections	6 months
Secondary	Hospitalization days	Totals days in-hospital	6 months
Secondary	Adverse events	Number of participants with: pneumonia within a week after the intervention; dyspeptic complaints collected at the time of rectal sampling; changes in bowel habit including diarrhea and constipation; discontinuation of FMT before completing the study protocol	6 months