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Transplantation of intestinal microbiota in primary Clostridium difficile infections

The intestinal microbiota trials investigate whether the supply of microbiota can treat or prevent diarrhea caused by toxigenic Clostridium difficile, which is a feared complication of antibiotic treatment.

Clostridium difficile bacteria. Illustration: CDC/James Archer

Objectives

We are investigating whether the supply of intestinal microbiota (i.e. fecal bacteria and –matter) is more effective than antibiotics in the prevention and treatment of first-time Clostridium difficile infections. The goal is to give patients better treatment in terms of both faster recovery and fewer recurrences of the disease.

Background

Clostridium difficile infections can occur due to disturbed intestinal microbial organisms after antibiotic treatment for another infection. Clostridium difficile infections varies in severity, from mild diarrhea and abdominal pain, to severe colitis that may be fatal. As the infection typically emerge in persons exposed to antibiotic treatment, it occurs frequently in hospitals and often prolongs hospitalization. The incidence of Clostridium difficile infections has increased over the last decades.

Standard treatment for Clostridium difficile infections are antibiotics, but around one in four patients experience persistent symptoms, or rapid relapse of the infection. Transmission of healthy intestinal microbiota is shown to be more effective than antibiotics as treatment for recurrent Clostridium difficile infections but, as of today, the patients have to suffer through multiple infections and antibiotic treatments before intestinal microbiota is an option.

Our hypothesis is that the supply of intestinal microbiota instead, or as adjuvant, to antibiotics is better than antibiotics alone in the treatment of first-time Clostridium difficile infections and in prevention of recurrent Clostridium difficile infections. We investigate this in two different trials. The pilot of the first trial was completed at the beginning of 2018 and the other will be launched soon.

We hope to show that treatment with intestinal microbiota in first-time Clostridium difficile infection can help reduce the use of antibiotics and costs associated with hospitalizations due to Clostridium difficile infections.

Trials

  1. Microbiota transplantation as treatment in first-time (primary) Clostridium difficile infection
    Scientific title: Fecal microbiota transplant for primary Clostridium difficile infection - a multicenter randomized controlled trial
     
  2. Microbiota transplantation to prevent relapse of Clostridium difficile infection
    Scientific Title: RCT of Microbiota Therapy to Prevent Recurrence of Clostridium difficile Infection after Antibiotic Treatment

Cooperation

The Clinical Effectiveness research group in collaboration with hospitals in Norway and scientific expertice in the United States are conducting the trials.

  • Oslo University Hospital Rikshospitalet, Oslo
  • Oslo University Hospital Ullevål, Oslo
  • Telemark hospital, Skien
  • Vestfold hospital, Tønsberg
  • Sørlandet Hospital HF, Kristiansand
  • Lovisenberg Diakonale Hospital, Oslo
  • Vestre Viken HF Bærum Hospital, Sandvika
  • Harvard T.H Chan School of Public Health, Boston (U.S.)
  • Karolinska Institute, Stockholm (Sweden)

Time frame

Trial 1 (pilot): 2015 – 2018

Trial 1 (main trial): Start fall 2019

Trial 2: Start fall 2019

References

Vincent C, Stephens DA, Loo VG, Edens TJ, Behr MA, Dewar K, et al. Reductions in intestinal Clostridiales precede the development of nosocomial Clostridium difficile infection. Microbiome. 2013;1(1):18.

Leffler DA, Lamont JT. Clostridium difficile Infection. N Engl J Med. 2015;373(3):287-8.

Dubberke ER, Olsen MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis. 2012;55.

Khanna S, Pardi DS. The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings. Expert Rev Gastroenterol Hepatol. 2010;4.

Barbut F, Richard A, Hamadi K, Chomette V, Burghoffer B, Petit JC. Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol. 2000;38(6):2386-8.

Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013;108(4):500-8.

Senior K. Faecal transplantation for recurrent C difficile diarrhoea. Lancet Infect Dis. 2013;13.

Tags: microbiota, transplantation, clostridium difficile, infection
Published Apr. 27, 2018 2:40 PM - Last modified Apr. 27, 2018 6:01 PM

Contact

Principal Investigator (PI)
Kjetil Kjeldstad Garborg, MD PhD, 
Oslo University Hospital,
University of Oslo

PhD Fellow
Frederik Emil Juul, MD
Oslo University Hospital,
University of Oslo