A Patient’s Fecal Transplant Went Horribly Wrong After Developing a Deadly Infection

Korin Miller
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From Prevention

  • The FDA issued a safety alert on Thursday after a patient who received a fecal transplant died.
  • The patient, who had a weakened immune system, developed an antibiotic-resistant infection that was a form of E.coli.
  • Doctors explain how fecal transplants are done and whether they’re typically safe.

Fecal transplants have been a buzzy (but gross-sounding) medical term thrown around a lot lately. But now the Food and Drug Administration (FDA) has some scary information about the practice: It can be deadly.

The FDA issued a safety alert on Thursday after one person who received a fecal transplant died. The procedure, which takes stool (aka poop) from a donor and places it in the body of a patient, is not approved by the FDA. In this case, two people with weakened immune systems received transplant fecal samples from one particular donor. They both developed an antibiotic-resistant infection that was a form of E.coli-something the stool wasn’t tested for in advance. One of the patients ended up dying due to the infection.

As a result, the FDA will now require that all stool samples used for fecal transplants be tested for drug-resistant bacteria and that donors be screened for drug-resistant infections before their stool can be used.

Fecal transplants are slowly becoming a mainstream treatment, but why exactly would you need one in the first place? Here, doctors weigh in on how the procedure is done and the risks to keep on your radar.

What is a fecal transplant, anyway?

Fecal transplants are a fairly new treatment that use the stool from a healthy person to help transfer healthy bacteria to the intestines of a patient. It’s usually used to treat cases of Clostridium difficile, bacteria that causes diarrhea and inflammation of the colon, that hasn’t responded to treatment with antibiotics.

A fecal transplant is actually really similar to a colonoscopy. The patient preps for a colonoscopy and a donor takes a laxative to make sure they have a bowel movement in the morning, per the Cleveland Clinic. The stool is mixed in a saline solution and filtered until only a brown liquid that contains bacteria remains.

The patient is given a drug like Imodium to help stop them up and then they’re given a colonoscopy, where the donor stool is injected into their bowels, explains Rudolph Bedford, MD, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, Calif. They’re encouraged to try to hold it all in for as long as possible (hence, the Imodium) to help the healthy bacteria take root.

People generally start to feel better within 24 to 48 hours, says Dr. Bedford, although he’s seen patients that take up to four days to start to see their symptoms go away.

So, how do they get this stool?

When fecal transplants were a newer thing, doctors would generally get donor stool from a patient’s significant other or a close loved one, Dr. Bedford says. Now, there are companies that actually supply this stuff. Dr. Bedford gets his stool shipped to him in the form of freeze-dried capsules.

Are fecal transplants safe?

In general, yes-and they may happen more in the future since Clostridium difficile are becoming more common in the U.S.

“It is safe as long as the person who is being transplanted is not immunocompromised in some way-that’s the biggest issue,” Dr. Bedford says. This means the patient would not have the ability to fight off an infection due to a weakened immune system-say, due to diseases like cancer, certain genetic disorders, or diabetes.

The stool also has to undergo “appropriate testing” to make sure to donors don’t have any infectious issues that could show up in their stool, and that was a big issue in the cases that the FDA flagged.

“Stool is teaming with bacteria and pathogens,” says infectious disease expert Amesh A. Adalja, MD, senior scholar at the John’s Hopkins Center for Health Security. “It’s really important that it’s screened properly.”

And while it seems like it would be simple to just do this at home, Dr. Adalja stresses that this “isn’t something that people should do on their own. It needs to be done under medical supervision or you risk transferring pathogens.”

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