- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02816437
FMT for MDRO Colonization in Solid Organ Transplant (FMT)
Fecal Microbiota Transplantation for the Treatment of Multidrug-Resistant Organism Colonization in Solid Organ Transplant Recipients
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is a pilot feasibility study to determine whether fecal microbiota transplantation (FMT) can suppress or reverse gastrointestinal carriage of MDROs in hospitalized solid organ transplant recipients with a history of one or more MDRO infections.
Study participants who meet inclusion/exclusion criteria and provide written, informed consent will provide a pre-FMT stool sample. Participants will be followed from the time of enrollment up to 3 months post FMT.
Specific organisms of interest that will be tested for by the stool cultures include vancomycin resistant enterococcus, carbapenem resistant Enterobacteriaceae and carbapenem resistant Pseudomonas. Eligible patients who demonstrate colonization with a positive culture for a specific organism of interest will be given FMT.
One FMT dose of a retention rectal enema (OpenBiome) will be administered by a nurse and supervised by our principal investigator and/or sub-investigators trained in performance of FMT.
Stool samples of study participants will be collected and analyzed as follows:
- Pre-FMT: Stool collection & storage in glycerol/flash frozen, to be shipped in dry ice
- 48 hours post FMT: Stool collection using RNA later kit provided by OpenBiome (in hospital)
- Day 7: Stool collection & storage in glycerol/flash frozen, to be shipped in dry ice
- Day 14: Stool collection using RNAlater kit (at home)
- Day 30: Stool collection & storage in glycerol/flash frozen (in hospital or clinic), to be shipped in dry ice
- Day 90: follow-up visit in clinic, final sample collected using RNAlater kit
Study Type
Phase
- Phase 1
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria
- Age ≥18 years old
- Solid organ transplant recipients: liver, intestinal, multivisceral transplants, heart, lung, pancreas or kidney transplant recipients
- Transplant recipient at least >30 days post solid organ-transplant
- Transplant recipient must be available locally for follow up to 6-months post FMT transplant
- Inpatient status at time of FMT
- History of at least one or more treated infections in the last 90 days (bacteremia, UTI, pneumonia or abdominal collection with a positive culture with MDRO) due to an MDRO and the MDRO is likely of enteric origin (carbapenem resistant enterobacteriaceae (CRE), vancomycin resistant enterococci (VRE) or carbapenem resistant Pseudomonas (CRP).
- Be without active infection for >15 days: bacteremia, UTI, pneumonia or abdominal collection.
- Be without a positive culture (except for stool) with MDRO (carbapenem resistant enterobacteriaceae (CRE), vancomycin resistant enterococci (VRE) or carbapenem resistant Pseudomonas (CRP)
- Patients are not receiving antimicrobials (therapeutic or suppressive) within 48 hours of FMT
- Solid organ prophylactic antimicrobials as per protocol will be held 24 hours before and 14 days post FMT e.g. trimethoprim/sulfamethoxazole 3x/week or dapsone 100 mg PO daily or weekly for PJP prophylaxis
- Ganciclovir or valgancyclovir for CMV prophylaxis if required as per protocol can be continued.
- Patients have a positive surveillance rectal culture for evidence of colonization.
Exclusion Criteria
- Inability to provide informed consent
- Physician-documented, severe allergy to nuts or other food allergens
- Patients with allergies to ingredients Generally Recognized As Safe " glycerol, sodium chloride
- Study participants hospitalized in the intensive care unit
- CMV IgG, EBV IgG and PCR negative at the time of consent
- Biological MELD score > 28 as defined by transplant surgeon
- Pregnancy or inability/unwillingness to use contraceptives.
- Autoimmune hepatitis
- Patients that received a new solid organ transplant within the last 30 days at the time of enrollment
- Patients on antibiotics treating an active infection or less than 2 weeks at the time of enrollment
- Any circulatory failure on vasopressors
- Respiratory failure (on mechanical ventilation) at the time of enrollment
- Renal failure (GFR <30 or dialysis) at the time of enrollment
- Any active Clostridium difficile infection regardless of severity
- Post-allogeneic hematopoietic stem cell transplant recipients
- ANC <1000/mm3
- HIV+ controlled or not well controlled on antiretroviral therapy
- At increased risk for peritonitis: presence of intra-abdominal devices, peritoneal dialysis.
- Previous FMT
- Patients undergoing treatment for liver or any other organ transplant rejection
- Patients with graft vs. host disease
- Patients with any active infection (bacteremia, pneumonia, urinary tract infection or abscess)
- Life expectancy <1-year post transplant
- Any clinical significant bleeding from a lower GI source (as defined as requiring blood transfusion, endoscopy or surgical or radiologic intervention) in the last 30 days.
- Any condition that the physician investigators deems unsafe, feel the risks of outweigh potential benefit, including other conditions or medications that the investigator determines puts the subject at greater risk from FMT
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: OpenBiome FMT retention enema
OpenBiome Fecal Microbiota Transplantation retention enema, one rectal application.
|
Keep enema frozen until ready for administration.
A single transfer of all 250mL of fecal material using universal precautions to a standard retention enema bag over 1 hour with material retained for at least 1 hour.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of participants with adverse events
Time Frame: 10 months
|
Overall rates of adverse events
|
10 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of MDRO decolonization
Time Frame: 10 months
|
Number of successful cases of MDRO decolonization
|
10 months
|
Rate of Recurrent MDRO infections
Time Frame: 10 months
|
Number of patients with recurrent MDRO infections
|
10 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Lilian Abbo, M.D, University of Miami
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 20160351
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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