Fecal transplant recipient dies from drug-resistant E coli

Takeaway

• Case report highlights potential for drug-resistant Escherichia coli-containing fecal microbiota transplant (FMT) oral capsules to transfer potentially fatal infections to recipients.
• Editorial: FMT alternatives needed.

Why this matters

• Ensure that capsulized FMT is screened before transfer.
• Weigh FMT benefits with associated risks.

Key points

• Patient 1: 69-year-old man with hepatitis C-associated liver cirrhosis; open-label study of FMT for refractory hepatic encephalopathy.
• Regimen: rifaximin prophylaxis before/during/3-week post-FMT treatment (15 FMT capsules × 5 q 3 weeks).
  • Day 17 post-FMT: antibiotics initiated for presumptive pneumonia; 4 days later, diagnostic paracentesis showed extended-spectrum beta-lactamase (ESBL)-producing E coli.
  • Subsequent carbapenem plus 14 days inpatient meropenem, followed by outpatient ertapenem led to clinical stabilization, ESBL clearance.
• Patient 2: 73-year-old man with therapy-related myelodysplastic syndrome, phase 2 trial to preemptively administer FMT oral capsules pre-/post-allogeneic hematopoietic cell transplantation.
  • Regimen: 15 FMT capsules, day 4, day 3 prehematopoietic cell transplantation plus cefpodoxime prophylaxis day 1 pretransplantation.
  • 8 days post-last FMT dose, developed fever, chills, altered mental status leading to hypoxia, labored breathing, ICU admission. Gram-negative rods on blood culture led to meropenem initiation, condition worsened, patient died 2 days later from sepsis. Final culture: ESBL-producing E coli.
• Follow-up genome analysis: FMT capsules from same donor.