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N Engl J Med. 2019 Nov 21;381(21):2043-2050. doi: 10.1056/NEJMoa1910437. Epub 2019 Oct 30.

Drug-Resistant E. coli Bacteremia Transmitted by Fecal Microbiota Transplant.

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From the Blood and Marrow Transplant Program (Z.D., Y.-B.C.), the Liver Center, Division of Gastroenterology (P.P.B., R.T.C.), and the Division of Infectious Diseases (M.T.S., M.K.M., S.T., E.L.H.), Massachusetts General Hospital, Harvard Medical School (Z.D., P.P.B., M.T.S., M.K.M., S.T., R.T.C., Y.-B.C., E.L.H.), and Day Zero Diagnostics (M.R.A.S., M.H.H.) - all in Boston.


Fecal microbiota transplantation (FMT) is an emerging therapy for recurrent or refractory Clostridioides difficile infection and is being actively investigated for other conditions. We describe two patients in whom extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli bacteremia occurred after they had undergone FMT in two independent clinical trials; both cases were linked to the same stool donor by means of genomic sequencing. One of the patients died. Enhanced donor screening to limit the transmission of microorganisms that could lead to adverse infectious events and continued vigilance to define the benefits and risks of FMT across different patient populations are warranted.

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