Using fecal microbiota transplantation to treat Clostridioides difficile infections

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This clinical trial evaluates the effectiveness of fecal microbiota transplantation (FMT) following standard antibiotic treatment (vancomycin or fidaxomicin) in patients experiencing their first episode or first recurrence of Clostridioides difficile infection (CDI). Participants will receive either the standard treatment alone or the standard treatment followed by FMT using oral capsules. The study aims to determine if FMT can reduce the risk of further CDI recurrences compared to standard antibiotic therapy alone. This approach is based on previous evidence suggesting FMT is effective for patients with multiple recurrences but has not been tested for first episodes or first recurrences.

Why it matters

Who can join: the full rules

Inclusion Criteria:

1. Adults (≥18 years old) at the time of informed consent
2. Informed consent signature
3. Medical record documentation of CDI defined as:

   a. A first CDI episode associated with risks factors for recurrence, defined as: i. No CDI episode within the last 8 weeks ii. Current combination of CDI signs and symptoms, confirmed by medical record documentation of microbiological evidence of C. difficile toxin and C. difficile in stools shown by a CDI PCR positive test with Ct \< 25 or a toxin A/B EIA positive test and without reasonable evidence of another cause of diarrhea, iii. Presenting at least one of the following risks factors for CDI recurrence:
   * age \>65 years-old,
   * hospitalization within the last 3 months,
   * use of proton pump inhibitors (PPI) within the last 3 months,
   * Charlson comorbidity index (CCI) \>2,
   * living in long term facility,
   * healthcare- associated CDI (see definition in section 7),
   * severe CDI episode (see definitions in section 6.1.2),
   * immunocompromised patient (except severely immunocompromised according to definitions in section 7.1),
   * history of prior CDI episode(s) (more than 8 weeks ago). OR b. A first CDI recurrence, defined as: i. Previous episode of treated and cured CDI within the last 8 weeks confirmed by medical record documentation of a clinical picture of CDI combined with a positive microbiological CDI test performed according to CDI diagnosis ESCMID guidelines ii. Current combination of CDI signs and symptoms, confirmed by medical record documentation of microbiological evidence of C. difficile toxin and C. difficile in stools shown by a CDI PCR positive test with Ct \< 25 or a toxin A/B EIA positive test , and without reasonable evidence of another cause of diarrhea..
4. No multiple episodes (no more than 2 CDI episodes) within 3 last months.
5. Already taking since less than 10 days or will start a course of antibiotics (vancomycin or fidaxomicin) to control recurrent CDI symptoms at the time of screening.
6. Willing and able to have FMT by capsule

Exclusion Criteria:

1. Severe-complicated CDI if at least one of the following signs or symptoms are:

   * ongoing at time of screening and related to CDI: hypotension, septic shock, elevated serum lactate, ileus,
   * or were present at any time of the CDI episode and related to CDI: toxic megacolon, bowel perforation, or any fulminant course of disease (i.e. rapid deterioration of the patient.
2. Prior FMT within 6 months of randomization,
3. Prior total colectomy, colostomy, ileostomy, or gastrectomy
4. Metronidazole already given alone for the treatment of the current CDI for more than 3 days,
5. Need for continued non-anti-CDI systemic antibiotics (should be stopped at randomization at the latest), except prophylactic doses of trimethoprim/sulfamethoxazole,
6. Anticipated indication for antibiotics treatment (for a non-CDI reason) in the next 8 weeks except prophylactic doses of trimethoprim/sulfamethoxazole
7. Other causes of chronic or acute diarrhea beyond CDI (chronic diarrhea is defined as loose/watery stools, which occur three or more times within 24 hours and last for 4 or more weeks)
8. Inflammatory bowel disease,
9. Patients with swallowing disorders, Zenker's diverticulum, gastroparesis, or prior small bowel obstruction,
10. Known hypersensitivity to vancomycin or fidaxomicin,
11. Pregnant/lactating women,
12. Estimated patient's life expectancy of less than 10 weeks,
13. Inability to follow protocol study procedures,
14. Inability to give informed consent,
15. Any condition or medications that will put the participant at greater risk from FMT according to the investigator,
16. Severely immunocompromised
17. No response to anti-CDI antibiotic treatment after at least 5 days of treatment (i.e. no diminution of the daily number of stools at BSS 6-7 compared to first day of treatment; or worsening of CDI severity parameters)

Where it's running

• Universitätsspital
  Basel, Basel, Switzerland Recruiting
• Inselspital Bern
  Bern, Canton of Bern, Switzerland Recruiting
• HFR Fribourg - Hôpital cantonal
  Fribourg, Canton of Fribourg, Switzerland Recruiting
• Hirslanden Klinik St Anna
  Lucerne, Canton of Lucerne, Switzerland Recruiting
• Kantonsspital St Gallen, HOCH
  Sankt Gallen, Canton of St. Gallen, Switzerland Recruiting
• Chuv
  Lausanne, Canton of Vaud, Switzerland Recruiting

Study contacts

• Principal investigator: Benoit Guery — Chuv
• Study coordinator: Benoit Guery, MD
• Email: benoit.guery@chuv.ch
• Phone: +41213141643

Similar studies

Other studies for the same condition or treatment. Recruiting studies are listed first.

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• Preventing recurrent C. difficile infection with the AZD5148 antibody

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• Preventing C. difficile recurrence with short-course oral vancomycin during later antibiotics

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• UDCA added to standard therapy to prevent C. diff recurrence

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.