The Antibiotic Resistance Crisis

The steady and alarming rise in antibiotic resistance poses one of the greatest challenges to public health and modern medicine. The U.S. CDC estimates that drug-resistant bacteria sicken more than 2 million people annually, causing 23,000 deaths and resulting in $20 billion in excess health-care costs and an additional $35 billion in lost productivity. The antibiotic resistance crisis is particularly devastating in hospitals and long-term care facilities, where such infections strike the most vulnerable patients with weak immune systems or chronic diseases.

Dr. Victor Nizet, a physician-scientist and member of the UC San Diego faculty for almost 20 years, explains that the roots of our current dilemma are multifactorial. Overzealous use of antibiotics in both clinical and agricultural settings, the departure of major pharmaceutical companies from antibiotic development (viewed as unprofitable), and simple Darwinian evolution of microbes exposed to life-or-death selective pressures each contribute profoundly. Can we, through public awareness, changes in medical practice, and scientific innovation, lift ourselves out of the hole that we have dug?

In the face of the exploding resistance crisis, Dr. Nizet and colleagues have turned their attention to discovering innovative future solutions that go “beyond antibiotics” to help patients with serious infections. These include strategies to strip the bacteria of their virulence factors and toxins to render them harmless, approaches to boost the natural antibacterial killing activity of our own white blood cells, and studies to understand how antibiotics and other existing drugs may work to cure infection in partnership with our immune system – not just how they work in a test tube. Dr. Nizet is spearheading a new initiative involving nearly 50 UCSD faculty named the “Collaborative to Halt Antibiotic-Resistant Microbes” or CHARM, which will make its debut later this year.

Watch The Antibiotic Resistance Crisis – Exploring Ethics .

When the Drug is Alive

Antimicrobial resistance is one of the most pressing global health issues of the 21st Century. In 2016, epidemiologist Steffanie Strathdee was involved in a remarkable case where she and her colleagues revived a hundred year old forgotten cure – bacteriophage therapy – which saved her husband’s life from a deadly superbug infection.

Strathdee and her husband Tom Patterson were vacationing in Egypt when Tom came down with a stomach bug. Steffanie dosed Tom with an antibiotic and expected the discomfort to pass. Instead, his condition turned critical.

Local doctors at an Egyptian clinic, an emergency medevac team and then a German hospital failed to cure him. By the time Tom reached the world-class medical center at UC San Diego, where both he and Steffanie worked, bloodwork revealed why modern medicine was failing: Tom was fighting one of the most dangerous, antibiotic-resistant bacteria in the world.

Frantic, Strathdee combed through research old and new and came across phage theory: the idea that the right virus, aka “the perfect predator,” can kill even the most lethal bacteria. Phage treatment had fallen out of favor almost 100 years ago, after antibiotic use went mainstream. Now, with time running out, she appealed to phage researchers all over the world for help and together they achieved a major medical breakthrough.

Since that experience, UC San Diego faculty have used intravenous phage therapy to successfully treat superbug infections in over a dozen other compassionate use cases, including the first use of a genetically modified phage cocktail. In 2018, the Center for Innovative Phage Applications and Therapeutics (IPATH) was launched at UC San Diego, the first dedicated phage therapy center in North America.

In this presentation, Strathdee shares the details of her family’s story and discusses ethical issues related to treating bacterial infections with viruses, where the drug is ‘alive.’

Watch When the Drug is Alive: Treating Superbug Infections with Bacteriophage Therapy.

A Personal Encounter with a Global Crisis

Epidemiologist Steffanie Strathdee and her husband, psychologist Tom Patterson, were vacationing in Egypt when Tom came down with what appeared to be a routine (if severe) case of food poisoning. Tom’s condition quickly deteriorated, and upon transfer to a hospital in Germany blood work revealed that he had contracted one of the most dangerous superbugs in the world, a condition that rendered modern standards of treatment useless. Following an emergency medevac to the medical center at UC San Diego, where both Steffanie and Tom worked, Tom suffered several episodes of septic shock and spent months in a coma.

An increasingly frantic Steffanie used her scientific training to research alternative solutions and stumbled upon “the perfect predator” in an all-but-forgotten treatment: bacteriophage therapy. Bacteriophage, or phage, treatment had fallen out of favor almost 100 years ago, largely due to the invention of antibiotics. Phages are naturally-occurring viruses capable of destroying even the most lethal bacteria, but in order to be effective they must be precisely matched to their prey. With the clock running down on Tom, Steffanie appealed to phage researchers worldwide. Working with allies that included the FDA, top university researchers, and a clandestine Navy biomedical center, a match was found; Tom was treated and made a remarkable recovery. Since then others have also been saved by this resurrected treatment.

The hard-won knowledge gained during Steffanie and Tom’s trial, and the alliances formed, helped to establish the Center for Innovative Phage Applications and Therapeutics (IPATH) at UC San Diego, the first phage therapy center in North America.

Steffanie and Tom’s memoir of their ordeal, The Perfect Predator, is a love story as well as a propulsive medical thriller. Though often near despair as Tom’s condition progressively worsened, Steffanie refused to concede defeat. The book also serves as a warning and a call to action, as Steffanie points to the rise of multidrug-resistant bacteria as a direct result of our overuse of antibiotics, particularly in livestock. The superbug crisis has assumed global proportions, and Steffanie argues that while phage therapy has tremendous promise, we must also focus our collective attention on the source of the crisis in order to prevent more cases like her husband’s.

Watch The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug with Steffanie Strathdee and Thomas Patterson