Fecal microbiota transplantation or FMT is an emerging medical procedure which a stool from a healthy donor is transferred into the digestive tract of a patient suffering Clostridium difficile colitis, an infection of the colon caused by Clostridium difficile bacteria. When an antibiotic (usually broad-spectrum), eliminates bacteria including the microbiome (the good bacteria) in the gut, opportunistic bacteria such as C. diff overtake and becomes pathogenic causing an illness. FMT can help restore the microbiome and reduce the number of C. diff bacteria in the gut.
Unfortunately, two patients received FMT from the same stool source that led them to have bacteremia, the presence of bacteria in the circulatory system. The type of bacteria found in their bloodstream is Escherichia coli with the ability to produce extended-spectrum beta-lactamase or ESBL. This type of bacteria is resistant to many antibiotics such as penicillin prescribed by many doctors. These cases were announced by the Food and Drug Administration in June 2019 safety alert because one case ended in the death of the patient.
The patient who died was a 73-year-old man who was undergoing treatment for myelodysplastic syndrome, a type of cancer in which immature blood cells do not fully mature. He received FMT through oral capsule with the donor stool.
After few days, the man developed fever, chills, febrile neutropenia (low neutrophil count), and change in mental status. He was treated with the antibiotic cefepime but developed hypoxia and labored respiration. Further blood culture test detected gram negative bacilli and was given another type of antibiotic called meropenem. Despite the loads of antibiotics given, the patient’s condition worsened and died of severe sepsis.
Further investigation revealed that each lot of three stool capsules, all coming from the same donor, contain ESBL-producing E. coli. More than 20 patients have taken the capsule from this donor and was contacted for stool screening and five were positive of the ESBL-producing E. coli
To limit the transmission of infectious bacteria and explain the benefits and risks of fecal microbiota transplantation across various patients, improved donor screening and continued surveillance was implemented.