Observational Study of C. Diff in Post-Transplant Patients (CDIFF)

October 30, 2019 updated by: University of Minnesota

An International Prospective Observational Study to Assess the Characteristics and Outcomes of Post-transplant Patients Treatment for C. Difficile Infections

The primary objective of this observational study is to estimate the 90-day response rates to treatment for a first episode of C. difficile infections (CDI) in adult transplant recipients.

Study Overview

Status

Completed

Conditions

Detailed Description

The primary objective of this observational study is to estimate the 90-day response rates to treatment for a first episode of C. difficile infections (CDI) in adult transplant recipients. This includes treatment success, recurrence, and complications in a prospectively followed cohort of solid organ and hematopoietic stem cell transplant patients. Patients who develop CDI within 2 years after transplantation will be enrolled and followed prospectively for 90 days after enrollment. Specimens of stool and serum collected within 48 hours of initiation of treatment will be stored locally for future epidemiologic studies to examine the immunologic and microbiologic risk factors for relapse and treatment failure, as well as complications of CDI in the transplant population. Response rates will be classified by organ type, hematopoietic stem cell transplant typ, treatment regimen, and immunosuppressive regimen.

Study Type

Observational

Enrollment (Actual)

132

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Argentina
      • Buenos Aires, Argentina, C1181ACH
        • Hospital Italiano de Buenos Aires
  • Denmark
      • Copenhagen, Denmark, 2100
        • CHIP, Department of Infectious Diseases, Section 2100
  • Germany
      • Cologne, Germany
        • Klinik I fur Innere Medizin der Universitat zu Koln, Studienburo fur Infektiologie u. HIV
  • Spain
      • Barcelona, Spain
        • Hospital Clinic De Barcelona
      • Madrid, Spain
        • Hospital Universitario Doce de Octubre
  • United States
    • Minnesota
      • Minneapolis, Minnesota, United States, 55455
        • University of Minnesota Medical Center
      • Rochester, Minnesota, United States, 55905
        • Mayo Clinic
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Hospital of the University of Pennsylvania
      • Pittsburgh, Pennsylvania, United States, 15213
        • University of Pittsburgh Medical Center

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Adults with a first episode of CDI within 2 years post solid-organ or stem-cell transplant.

Description

Inclusion Criteria:

  • Age ≥ 18 years
  • Signed informed consent
  • Transplant recipient (solid organ, stem cells, or bone marrow) within past 2 years
  • Currently diagnosed with first CDI after transplant, defined by (1) presence of diarrhea (at least 3 loose stools within a 24-hour period), AND (2) detection of C. difficile cytotoxin in stools by cytotoxin assay, or toxigenic culture, or polymerase chain reaction (PCR) testing for toxin, or enzyme immunoassay, or endoscopic presence of pseudomembranes with the detection of C. difficile in tissue biopsies

Exclusion Criteria:

  • Previous episode of CDI anytime after transplant
  • Current treatment for another infectious cause of diarrhea (bacterial, viral, or parasitic) at the time of the current CDI diagnosis

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
CDI patients
Adults with a first episode of CDI within 2 years after solid-organ or stem-cell transplant.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Response to antibiotic treatment for CDI: clinical cure
Time Frame: 90 days
The planned first course of CDI treatment was completed with resolution of symptoms or less than 3 loose stools per day for at least two consecutive days maintained until end of treatment and two days after treatment course ended.
90 days
Response to antibiotic treatment for CDI: sustained clinical cure
Time Frame: 90 days
Clinical cure achieved and maintained for 40 days post treatment initiation without recurrences, complications, ICU with CDI, or death as defined below
90 days
Response to antibiotic treatment for CDI: global cure
Time Frame: 90 days
Clinical cure achieved and maintained for 90 days post treatment initiation without recurrences, complications, including ICU with CDI, or death as defined below.
90 days
Response to antibiotic treatment for CDI: relapse
Time Frame: 90 days
A new episode of CDI after clinical cure and within 4 weeks after treatment initiation.
90 days
Response to antibiotic treatment for CDI: reinfection
Time Frame: 90 days
A new episode of CDI after clinical cure and beyond 4 weeks after treatment initiation
90 days
Response to antibiotic treatment for CDI: complications
Time Frame: 90 days
The study will collect the incidence of specific complications as assessed by the site investigator: perforation of the colon; development of toxic megacolon; need for abdominal surgery related to CDI; transfer to the ICU with CDI; death from CDI-related cause.
90 days

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Describe patients who are successfully treatment for CDI
Time Frame: 90 days
Patients will be described by demographics (age, race, sex), type of transplant received, specific treatment for CDI, and the strain of C. difficile with which they were infected.
90 days
Describe differences in antibiotic regimens and other CDI treatments across geographic regions (US, Europe, South America)
Time Frame: 90 days
90 days
All-cause mortality
Time Frame: 90 days
90 days
Response to treatment for CDI (as defined above) by treatment regimen
Time Frame: 90 days
90 days
Response to treatment for CDI (as defined above) by type of transplant (solid organ vs. hematopoietic/stem cell)
Time Frame: 90 days
90 days
Assay differences across sites
Time Frame: 90 days
Describe assays used to detect C. difficile organisms and toxin in stool by site at which participants are enrolled.
90 days

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Minnesota

Collaborators

Merck Sharp & Dohme LLC
Astellas Pharma Inc
Medical Research Council
Washington D.C. Veterans Affairs Medical Center
International Network for Strategic Initiatives in Global HIV Trials (INSIGHT)
Copenhagen HIV Programme

Investigators

  • Study Chair: Jean-Michel Molina, MD, Hôpital Saint-Louis, Service de Maladies Infectieuses

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

August 22, 2016

Primary Completion (Actual)

October 30, 2018

Study Completion (Actual)

October 30, 2018

Study Registration Dates

First Submitted

April 12, 2016

First Submitted That Met QC Criteria

April 18, 2016

First Posted (Estimate)

April 21, 2016

Study Record Updates

Last Update Posted (Actual)

November 1, 2019

Last Update Submitted That Met QC Criteria

October 30, 2019

Last Verified

October 1, 2019

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 1605M87565

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

Study Data/Documents

  1. Study Protocol

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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