A Trial of Encapsulated Fecal Microbiota for Vancomycin Resistant Enterococcus Decolonization
Condition: Antibiotic Resistant Strain
Intervention: Encapsulated fecal microbiota preparation; Encapsulated placebo
Intervention description: 30 capsules; 30 capsules
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 9.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: vancomycin resistant enterococcus; VRE; decolonization; VRE colonization; fecal microbiota transplantation; FMT; FMT capsule; capsule; antimicrobial resistance; antibiotic resistance; MDRO; multidrug-resistant organism; OpenBiome

Summary:

      The objective of this study is to provide preliminary insight into the safety and efficacy of
      fecal microbiota transplantation (FMT) for the eradication of gastrointestinal carriage of
      vancomycin-resistant Enterococcus.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Adults 18 years or older at the time of enrollment.

          -  Able to provide signed and dated informed consent.

          -  Identified as VRE-positive by a stool culture within last 14 days.

          -  Women of childbearing potential in sexual relationships with men must use an
             acceptable method of contraception§ from 30 days prior to enrollment until 4 weeks
             after completing study treatment.

          -  Males must agree to avoid impregnation of women during and for four weeks after
             completing study treatment through use of an acceptable method of contraception*.

               -  Includes, but is not limited to, barrier with additional spermicidal foam or
                  jelly, intrauterine device, hormonal contraception (started at least 30 days
                  prior to study enrollment), intercourse with men who underwent vasectomy.

                    -  Includes, but is not limited to, barrier with additional spermicidal foam or
                       jelly and vasectomy.

        Exclusion Criteria:

          -  Female patient who are pregnant, lactating or planning on becoming pregnant during
             study. Female patients of childbearing potential will undergo a pregnancy test, and be
             excluded from the study if positive.

          -  Inability (e.g. dysphagia) to or unwilling to swallow capsules.

          -  Active antibiotic resistant bacteria (ARB) or gastrointestinal infection at time of
             enrollment.

          -  Patient received antibiotics in the last 48 hours. Patients will be eligible to enroll
             if antibiotic therapy is discontinued for at minimum 48 hours prior to randomization.
             Does not include antibiotics used for prophylaxis or topical antibiotics.

          -  Requires continued antibiotic use or anticipates antibiotic use in the upcoming 4
             weeks. Does not include antibiotics used for prophylaxis or topical antibiotics.

          -  Unwilling to withhold probiotics for a minimum of 48 hours prior to providing a
             screening stool sample.

          -  Known or suspected toxic megacolon and/or known small bowel ileus.

          -  Major gastrointestinal surgery (e.g. significant bowel resection) within 3 months
             before enrollment. This does not include appendectomy or cholecystectomy.

          -  History of total colectomy or bariatric surgery.

          -  Admitted to or expected to an intensive care unit for medical reasons (not just
             boarding). Patients residing in a nursing home, long-term care facility or
             rehabilitation center may be enrolled.

          -  Concurrent intensive induction chemotherapy, radiation therapy or biological treatment
             for active malignancy. Patients on maintenance chemotherapy may be enrolled only after
             consultation with medical monitor.

          -  Unable or unwilling to comply with protocol requirements.

          -  Expected life expectancy < 6 months

          -  Previous FMT or microbiome-based products at any time excluding this study.

          -  Patients with a history of severe anaphylactic or anaphylactoid food allergy.

          -  Solid organ transplant recipients ≤ 90 days post-transplant or on active treatment for
             rejection.

          -  Neutropenia (≤500 neutrophils/mL) or other severe immunosuppression. Anti-TNF will be
             permitted. Patients on monoclonal antibodies to B and T cells. glucocorticoids,
             antimetabolites (azathioprine, 6-mercaptopurine, methotrexate), calcineurin inhibitors
             (tacrolimus, cyclosporine) and mycophenolate mofetil may be enrolled only after
             consultation with the medical monitor.

          -  If at risk for CMV/EBV associated disease (at investigator's discretion, e.g.
             immunocompromised), negative IgG testing for cytomegalovirus (CMV) or Epstein Barr
             Virus (EBV).

          -  A condition that would jeopardize the safety or rights of the subject, would make it
             unlikely for the subject to complete the study, or would confound the results of the
             study.