- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03865706
Inulin for Infections in the Intensive Care Unit
Prebiotic Inulin to Limit Antimicrobial-Resistant Infections During Critical Illness: A Phase II Clinical Trial
Normal gut bacteria prevent colonization and subsequent infection with MDR organisms (MDROs) through competition for resources and other mechanisms. During critical illness, this function of the microbiome is lost and there are no current treatments to restore it. Preliminary data indicates that the prebiotic fiber inulin is safe and may alter the gastrointestinal microbiome to improve gut barrier function, decrease colonization with MDROs, and reduce downstream risk for intensive care unit (ICU)-acquired MDR infections. However, the impact of inulin during critical illness is unknown. This double-blind, randomized clinical trial will test inulin for the prevention of antibiotic resistant infections in the ICU.
The trial's specific aims are to determine (1) the feasibility, tolerability, and safety of inulin in the intensive care unit; (2) the impact of inulin on gut colonization with antibiotic-resistant pathogens; and (2A/exploratory) the impact of inulin on ICU-acquired antibiotic-resistant infections.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Daniel E Freedberg, MD, MS
- Phone Number: 8579989370
- Email: def2004@cumc.columbia.edu
Study Contact Backup
- Name: Elissa Lynch
- Email: el2888@cumc.columbia.edu
Study Locations
-
-
New York
-
New York, New York, United States, 10023
- Columbia University Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Hospitalized in an eligible medical ICU
- Age ≥ 18 years old at the time of hospitalization
- With sepsis as defined by the Sepsis-3 (2016) consensus as a known or suspected infection with a SOFA score of ≥2 points above baseline
- Received broad-spectrum antibiotics within the last 24 hours or ordered and pending administration
- Able to complete enrollment within 4 hours of ICU admission for administration of the intervention within 6 hours of ICU admission
Exclusion Criteria:
- Inability to receive oral or enteric fluids
- Inulin allergy
- Hyponatremia (serum sodium ≤128 mEq/L)
- Immunosuppression, defined as history of solid organ transplant or as receipt of ablative chemotherapy, steroids at the equivalent of ≥5 mg/day prednisone, antimetabolites, anti-TNFα agents, calcineurin inhibitors, or mycophenolate
- Surgery involving the intestinal lumen within 30 days or known intestinal strictures
- Do Not Resuscitate (DNR) or Do Not Intubate (DNI) status, or "no escalation of care" orders
- Lack capacity for consent and no appropriate Legally Authorized Representative (LAR)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Inulin 32 g/day
Critically ill adults who are receiving broad-spectrum antibiotics will also receive inulin oral suspension (16g twice daily) for a minimum of 7 days.
|
Inulin powder, derived from chicory root and re-suspended in 250cc water Dosage will be either 8g twice a day or 16g twice a day - dissolved in 250cc sterile water, given oral or via enteric tube
Other Names:
Standard of care treatment for infections
Other Names:
|
Experimental: Inulin 16 g/day
Critically ill adults who are receiving broad-spectrum antibiotics will also receive inulin oral suspension (8g twice daily) for a minimum of 7 days.
|
Inulin powder, derived from chicory root and re-suspended in 250cc water Dosage will be either 8g twice a day or 16g twice a day - dissolved in 250cc sterile water, given oral or via enteric tube
Other Names:
Standard of care treatment for infections
Other Names:
|
Placebo Comparator: Placebo
Critically ill adults who are receiving broad-spectrum antibiotics will also receive placebo oral suspension for a minimum of 7 days.
|
Standard of care treatment for infections
Other Names:
250cc sterile water alone, given twice daily a sweetener is added to the water to create identical flavor
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Within-individual change in SCFA producer level
Time Frame: modified intent-to-treat, comparing baseline vs Day 3 levels of SCFAs among those who receive one or more doses of the intervention and complete both assessments
|
relative abundance (i.e., proportion) of SCFA producing bacteria within each treatment group, will be assessed via 16S sequencing of rectal swabs
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modified intent-to-treat, comparing baseline vs Day 3 levels of SCFAs among those who receive one or more doses of the intervention and complete both assessments
|
MDRO colonization status
Time Frame: ICU Day 3, calculated in a similar manner as outcome 1
|
proportion of patients who are MDRO colonized within each treatment group, with MDRO colonization status classified categorically based on the presence or absence of MRSA, VRE, or Gram negative bacteria with CFTX non-susceptibility
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ICU Day 3, calculated in a similar manner as outcome 1
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MDR infections
Time Frame: through 30 days
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proportion of patients with culture-proven infections within each treatment group, with culture-proven infections defined as those that have (1) an organism meeting MDRO criteria from a clinical culture, (2) signs and symptoms of infection by CDC/NHSN guideline definitions, and (3) receive appropriate antibiotics from the treating team
|
through 30 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Nutritional intake
Time Frame: through Day 3 and through Day 7
|
proportion of goal calories consumed within each treatment group, after adjusting for death
|
through Day 3 and through Day 7
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ICU length of stay (LOS)
Time Frame: through ICU Day 30
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compared between groups, after adjusting for death as a competing risk
|
through ICU Day 30
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Multi-omic approach to changes related to inulin
Time Frame: outcomes focus on Day 3 and re-analyzed based on Day 7
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overall goal is to understand effects of inulin: will compare SCFA level in whole stools, overall taxonomy, functional metagenomics, metabolomics, and sepsis biomarkers between groups
|
outcomes focus on Day 3 and re-analyzed based on Day 7
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Daniel E Freedberg, MD, MS, Columbia University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- AAAS2576
- PR181960 (Other Grant/Funding Number: Department of Defense)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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