Doctors report first death from fecal microbiota transplant
73-year-old man died and another person became sick after receiving fecal microbiota transplants.
The donor stool that was used for the transplants contained a relatively rare type of drug-resistant bacteria called extended-spectrum beta-lactamase-producing E. coli (ESBL-producing E. coli).
The man who died had been a participant in a clinical trial at Massachusetts General Hospital (MGH) and had received fecal transplant capsules (made in November) with fecal material from a stool donor. Tests that were run after the man died revealed that the stool contained the rare strain of drug-resistant E. coli.
Scientists at MGH had begun screening for this type of bacteria in January, but they did not test capsules that had already been produced: “We didn’t think of it. The prevalence of these organisms in healthy individuals is so low,” says Elizabeth Hohmann who runs the laboratory at MGH that made the capsules. “In retrospect, it was like, ‘Oh, my gosh, of course we should have done that.’ But it didn’t happen.”
All individuals who donated stool underwent intense screening, including blood tests, a review of their medical history and tests for other types of resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
Some of the capsules that were made from the stool of donor 46 were frozen and kept for any further testing that may be needed. In May, when MGH doctors realized the donor 46 capsules may be the source of infection, those stored samples were then tested and blood samples were taken from affected patients.
Those tests revealed that the bacteria found in the patients’ blood and in the capsules were of a similar genetic makeup and were resistant to similar antibiotics. The bacteria had also not been identified in stool samples taken from the patients prior to transplant.
“It’s pretty clear that these are identical strains,” says Hohmann. “It’s more likely I’m going to win two lotteries than that this is not related [to the capsules]. I think this is definitive.”
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