Clinicians from Harvard Medical School have reported two cases of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteraemia linked to faecal microbiota transplantation (FMT), one of which proved fatal.
Patient 1 was a 69-year-old man with cirrhosis attributed to hepatitis C virus who was enrolled in an open-label trial of FMT oral capsules to treat refractory hepatic encephalopathy (NCT03420482). No adverse events were reported until 17 days after the final FMT dose, at which point signs of infection were documented. Treatment with piperacillin-tazobactam was initiated but was switched to carbapenem after ESBL-producing E. coli was identified in blood cultures. He completed 14 days of meropenem followed by ertapenem. His condition remains stable, with negative stool sample on follow-up stool.
Patient 2 was a 73-year-old man with therapy-related myelodysplastic syndrome enrolled in a phase 2 trial to pre-emptively administer FMT oral capsules before and after allogeneic haematopoietic cell transplantation (NCT03720392). Eight days after the last FMT dose, the patient developed signs of infection, which progressed and ultimately required mechanical ventilation. He died from sepsis two days later. Final blood cultures showed ESBL-producing E. coli.
Both cases were linked to the same stool donor through genomic sequencing.