Clinical trial NCT04188743: Decolonization of Gram-negative Multi-resistant Organisms (MDRO) with Donor Microbiota (FMT)
Official title: DEKODON: Decolonization of Gram-negative Multi-resistant Organisms (MDRO) with Donor Microbiota (FMT)
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
PHASE3
Conditions: Resistance Bacterial
Keywords: Fecal Microbiota Transplantation
Hospitals, Isolation
Drug Resistance, Multiple, Bacterial
Gram-Negative Bacteria
Gastrointestinal Microbiome
Lead sponsor: University Hospital, Ghent
Sponsor class: OTHER
Collaborators: name: Research Foundation Flanders
First posted: 2019-12-06
Enrollment: 150
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: 150 participants will be randomly allocated to an "intervention" group (100p) and a "no intervention" group (50p). Participants in the "intervention" group will be randomised (double blind) to either fecal microbiota transfer with donor stool (allogenic FMT) or fecal microbiota transfer with own stool (autologous FMT). Participants in the "no intervention" group will be monitored without receiving a fecal microbiota transfer.
Primary purpose: TREATMENT

Brief summary: Colonization by Multiple Drug Resistant Organisms (MDROs) during patient hospitalization requires expensive isolation measures and renders the return or transfer to other departments or institutions often impossible. Currently there is no specific treatment available. Patients have to wait for spontaneous clearance which can take months or does not happen at all.

The study will test the effect of Fecal Microbiota Transfer (FMT) on gut MDRO colonization. The focus will be on patients with a long-term colonization by Gram-negative bacteria for which isolation is warranted. Participants will be randomized into two treatment groups; allogenic FMT versus autologous FMT. A third group of participants will be monitored but will not receive an FMT. Decolonization rate will be compared one month after treatment. Additionally gut microbial composition will be studied up to one year after FMT.

Detailed description: This double-blind controlled randomized study will test the efficacy of Fecal Microbiota Transfer (FMT) on gut Multiple Drug Resistant Organism (MDRO) colonization.

Participants:

The study targets hospitalized patients (\>18 years old) that need to stay in isolation because of colonization by Carbapenem-resistant Enterobacteriales (CRE), non-E. coli Enterobacteriales that produce extended spectrum beta-lactamase (ESBL) or Multi Drug Resistant (MDR) Pseudomonas and MDR Acinetobacter species. Participants will be randomized in two groups (allogenic and autologous FMT). Additionally a third group of participants will be monitored without intervention.

Treatment:

Participants in the allogenic FMT- group will receive treatment using healthy donor microbiota preferably through naso-duodenal/-jejunal administration (Cortrak). Donor material will be supplied by the Ghent Stool Bank. The colonization status will be monitored on a regular basis (at least once per week) by culturing fecal swabs. Additionally fecal samples will be taken on fixed time points for microbial composition analysis (16S ribosomal ribonucleic acid metagenomics).

Controls:

Participants in the autologous FMT-group will will receive an FMT with their own microbiota to account for the effects of the intervention itself. Participants in the "no intervention" group will not receive an FMT. Both control groups will be monitored and sampled identically to the allogenic FMT-group.

Outcome:

The primary outcome (MDRO-decolonization rate in treatment versus control) will be evaluated 1 month after FMT. Secondarily, safety and tolerability of the treatment will be assessed. The patients will be monitored up to 1 year after treatment to evaluate microbiome composition and to define parameters in the microbiome that are associated with clinical outcome.

Eligibility criteria: Inclusion Criteria:

* Participants must be at least 18 years of age, and must sign the 'informed consent' form and thus agree with the data collection, sampling and FMT.
* At least 2 consecutive confirmations of MDRO colonization in faeces, which complicate the necessary follow-up and/or therapy for the patient.
* Participants must be able to endure the treatment (evaluated by treating physician).

Exclusion Criteria:

* Inflammatory bowel disease (Crohn's disease, ulcerative colitis ...)
* Diagnosed hereditary blood disease (Haemophilia, Von Willebrand ...)
* Chronic liver disease
* Active drug use or alcohol abuse / dependence, which according to the researchers' opinion may interfere with the patient's participation in the study
* Simultaneous use of probiotics (except yoghurt)
* Existing immune deficiency (congenital or acquired), or concomitant immunomodulatory treatment (including systemic corticosteroids) in the 12 weeks prior to randomization, nasal or inhaled corticosteroid use is permitted
* Positive pregnancy test (or potentially pregnant)
* Breastfeeding
* Severe food allergy (anaphylaxis, urticarial)
* Antibiotic treatment up to 7 days before FMT, or planned to start within one month after FMT.

Primary outcomes:
measure: Number of participants with decolonization success/failure
timeFrame: 1 month after treatment
Secondary outcomes:
measure: Side effects
timeFrame: up to 1 year after treatment
measure: Treatment effect on microbial community in participants
timeFrame: up to 1 year after treatment
measure: Treatment tolerability
timeFrame: 1 month after treatment
Other outcomes:
Locations:
city: Ghent
country: Belgium
facility: Ghent University Hospital
state: Oost-Vlaanderen
Study officials:
affiliation: University Hospital, Ghent
name: Bruno Verhasselt, Prof. Dr.
role: PRINCIPAL_INVESTIGATOR
References: