Response to Emerging Antimicrobial Resistance With Containment Microbiota Therapy (REACT)

Response to Emerging Antimicrobial Resistance With Containment Microbiota Therapy

REACT is a phase two, open-label, randomized, controlled trial of microbiota therapy (MT) to reduce colonization with multi-drug resistant organisms (MDRO). REACT is designed to assess the safety and efficacy of MT administered to subjects colonized with a MDRO. The overarching hypothesis is that MT can reduce MDRO colonization with safety that is comparable to observation.

Study Overview

• Status: Recruiting
• Conditions: Multi-Drug Resistant Organism Colonization
• Intervention / Treatment: Drug: Allogeneic Microbiota in Glycerol (9%) (AMG)

Detailed Description

REACT is a phase two, open-label, randomized, controlled trial of microbiota therapy (MT) to reduce colonization with multi-drug resistant organisms (MDRO) in patients admitted to long-term care facilities. REACT is designed to test the safety and efficacy of instillation of donor intestinal microbiota.

Patients admitted to long-term care facilities (e.g. long-term acute care hospitals and ventilator-capable skilled nursing facilities) found to be MDRO colonized during prevalence screening activities performed in the related APPS study.

Facilities undergo prevalence sampling that involves participant peri-rectal, inguinal, and stool sampling to estimate the prevalence of targeted MDROs (CRE, ESBL, VRE, MDRP) under the accompanying APPS protocol. Patients who are positive with at least one targeted MDRO are eligible for an Emory manufactured MT product (via rectal enema or feeding tube), or observation followed by repeat sampling at Days 7, 14, 21, and 28. Participants will be followed with collection of data on adverse events/safety/changes in medications at Days 0, 7, 14, 21, 28, and followed up once a month for 6 months, after MT administration.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Deepti Suchindran, PhD; Phone Number: 404-727-9193; Email: deepti.rao.suchindran@emory.edu
• Study Contact Backup: Name: Michael Woodworth, MD; Email: michael.holmes.woodworth@emory.edu

Study Locations

• United States
  • Georgia
    • Atlanta, Georgia, United States, 30329
      • Recruiting
      • A.G Rhodes Wesley Woods
      • Contact: Michael Woodworth, MD; Phone Number: 404-234-8452; Email: Michael.holmes.woodworth@emory.edu
    • Decatur, Georgia, United States, 30030
      • Recruiting
      • Emory Long Term Acute Care (LTAC)
      • Contact: Michael Woodworth, MD; Phone Number: 404-234-8452; Email: Michael.holmes.woodworth@emory.edu
  • Illinois
    • Hinsdale, Illinois, United States, 60521
      • Recruiting
      • RML Specialty Hospital
      • Contact: Rachel Madernach, MD; Phone Number: 312-947-2426; Email: rachel_l_medernach@rush.edu
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19146
      • Recruiting
      • Penn Medicine Rittenhouse
      • Contact: Brendan Kelly, MD; Phone Number: 215-316-5151; Email: brendank@pennmedicine.upenn.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Be able (or have available a Legal Authorized Representative who is able) to understand and sign a written informed consent document.
2. Be at least 18 years old at the time of consent.
3. Be able to comply with all study protocol requirements, including able to receive MT as retention enema or via enteral feeding tube and be available for the duration of the study follow up.
4. Be colonized with a target MDRO (CRE, VRE, ESBL, MDR Pseudomonas) as detected by bacterial culture of stool or peri-rectal swab (collected in companion APPS facility prevalence sampling protocol).
5. Be able to discontinue or complete planned courses of antibiotics, probiotics, and other microbiota restoration therapies by Day -1 and not resume until after Day 28.
6. The effects of the MT on the developing human fetus are unknown. For this reason, persons of child-bearing potential (POCBP) and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation.
7. Agree to refrain from receptive anal intercourse until the last biological specimen (stool sample or peri-rectal swab) is collected (Day 28).

Exclusion Criteria:

1. Are pregnant, breastfeeding, lactating, or planning a pregnancy during study duration (through 4 weeks after the last dose of investigational product, or MT), if POCBP.

2. Have known uncontrolled intercurrent illness(es):

   1. Symptomatic congestive heart failure
   2. Acute coronary syndrome
   3. Cardiac arrhythmia
   4. Untreated in-situ colorectal cancer
   5. Toxic megacolon
   6. Ileus
   7. Positive stool studies without completion of treatment course (including ova and parasites, Salmonella spp, Shigella, Campylobacter, and other enteropathogens).
   8. other acute illness that in the opinion of the investigator could affect the safety of the participant or make study data uninterpretable.
3. Are on systemic antibiotics for any reason other than treatment of recent MDRO infection or clear anticipated need for antibiotics during the follow up period that cannot be rescheduled (e.g. fluoroquinolone prophylaxis for percutaneous nephrostomy tube exchange, prolonged antibiotic course for endocarditis). Participants must complete the planned antibiotic course by study Day -1.

4. Have a compromised immune system, defined as:

   1. AIDS with CD4+ T-cell count <200 and detectable HIV viral load on most recent assay.
   2. Absolute neutrophil count (ANC) <1,000 neutrophils / mL on day of enrollment.
   3. Active malignancy requiring intensive induction chemotherapy, radiotherapy, or biologic treatment within 2 months prior to enrollment.
   4. History of hematopoietic cell transplantation, either allogeneic or autologous in the last 1 year.
5. Have a history of significant food allergy that led to anaphylaxis or hospitalization.
6. Have a life expectancy of 24 weeks or less

7. Have any condition that, in the opinion of the investigator, might interfere with study objectives or limit compliance with study requirements, including but not limited to:

   1. Known active intravenous drug or alcohol abuse
   2. Uncontrolled psychiatric illness
   3. Social situations (e.g. incarceration)
8. Received an interventional agent (drug, device, or procedure) within 28 days prior to enrollment.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1: microbiota therapy (MT); Group 1 will offer Microbiome therapeutic (MT) to all MDRO-positive patients (i.e., intervention condition).	Drug: Allogeneic Microbiota in Glycerol (9%) (AMG); Participants will receive an Emory-manufactured MT product, delivered as 250mL via rectal enema or 30mL instillation via an existing functioning feeding tube with the rate adjusted to participant tolerance. Participants will receive three doses over the first seven days of the study.; Other Names: Fecal Microbiota Transplant (FMT); Microbiome therapeutic (MT); Stool from healthy donors in saline suspension with 9% glycerol by volume
No Intervention: Group 2: Observation; Group 2 will be assigned to observation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Difference in number of solicited Adverse Events (AEs)	Difference in number of solicited AEs between Day 0 and Day 7 in AMG-treated vs Observation participants.	Day 0, Day 7 post-intervention
Difference in severity of solicited AEs	Difference in severity of solicited AEs will be compared in AMG-treated vs Observation participants. Graded as mild, moderate or severe, up to 7 days post-intervention.	Day 0, Day 7 post-intervention
Difference in number of unsolicited AEs	Difference in number of unsolicited AEs between Day 0 and Day 28 in AMG-treated vs Observation participants.	Day 0, Day 28 post-intervention
Difference in severity of unsolicited AEs	Difference in severity of unsolicited AEs will be collected between Day 0 and Day 28. Graded as mild, moderate or severe and compared in AMG-treated vs Observation participants	Day 0 and Day 28
Difference in proportion of participant stool positive cultures for any target MDRO among AMG-treated compared to Observation participants	Difference in proportion of participant stool cultures at Day 28 positive will be measured for any target MDRO among AMG-treated compared to Observation participants	Day 28 post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Count of serious AEs (SAEs)	Count of serious AEs (SAEs) between Day 0 and Month 6 (Day 180) censored by last telephone visits or death, whichever is later.	Day 180
Count of AEs of Special Interest (AESIs)	Count of AEs of Special Interest (AESIs) at day Day 180, censored by last telephone visit or death, whichever is later.	Day 180
Proportion of stool cultures at Day 28 positive for category-specific MDROs	Proportion of stool cultures at Day 28 positive for category-specific MDROs (e.g. ESBL, CRE, MDRP, VRE).	Day 28

Collaborators and Investigators

• Sponsor: Emory University
• Collaborators: Centers for Disease Control and Prevention
• Investigators: Principal Investigator: Michael Woodworth, MD, Emory University

Study record dates

Study Major Dates

• Study Start (Actual): January 13, 2025
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: March 13, 2024
• First Submitted That Met QC Criteria: March 13, 2024
• First Posted (Actual): March 20, 2024

Study Record Updates

• Last Update Posted (Estimated): November 5, 2025
• Last Update Submitted That Met QC Criteria: November 4, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Antibiotic Resistance; Fecal Microbiota Transplant; Long-Term Care Facilities; Multi-Drug Resistant Organism
• Additional Relevant MeSH Terms: Organic Chemicals; Therapeutics; Carbohydrates; Alcohols; Biological Therapy; Triose Sugar Alcohols; Sugar Alcohols; Glycerol; Fecal Microbiota Transplantation
• Other Study ID Numbers: STUDY00007230; U54CK000601 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

Deidentified participant solicited adverse event and serious adverse event data will be shared.

Isolate genomic data and participant metagenomic data will be shared in public repositories (NCBI) at time of publication

• IPD Sharing Time Frame: Data will become available at time of publication.
• IPD Sharing Access Criteria: Sequence data access will not be restricted. Additional participant-level data will be shared by review of PI of proposing investigators and appropriate ethical approval (e.g. IRB) if any.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No