What the New York Times calls "a frank and public act of self-examination" has emerged from a Boston medical center following the death of a fecal transplant patient after receiving contaminated stool. In an article published in the New England Journal of Medicine, doctors at Massachusetts General Hospital document the events leading up to the death of the 73-year-old blood cancer patient, which was first reported by the FDA in June. He and another patient, a 69-year-old with liver disease, had been given stool last spring that hosted drug-resistant E. coli bacteria, both samples from the same donor. The liver patient became seriously ill after his fecal microbiota transplant (aka FMT), which aims to restore a patient's microbiome, or gut organisms. That man recovered, but the cancer patient was put on a breathing machine a week after his last FMT; he died two days later from a blood infection.
One big misstep: Although the hospital had tightened screening for stool donations starting in January based on new FDA guidelines (FMT isn't FDA approved), older samples were kept, untested, in a freezer. "It wasn't obvious to a lot of smart people here. We didn't think to go back in time," Dr. Elizabeth Hohmann, the article's lead author, says, adding to STAT that "the prevalence of these organisms in healthy individuals is so low." Hohmann adds that "20/20 hindsight" also made them realize that antibiotics given to the two patients before their fecal transplants may have helped the E. coli bacteria flourish. The Times notes that while the Boston hospital uses fecal transplant material produced in-house, most treatments in the US use material from the OpenBiome nonprofit stool bank, which has been screening for antibiotic-resistant E. coli since 2016, with no reported cases of "serious adverse events" from FMTs. (Read more fecal transplant stories.)