By: Dr.Lalit Mehra
Little did Brandon Noble know that his career as a professional National Football League player was coming to an end, when he developed a spreading infection in his knee, following an arthroscopic knee procedure. Like most of us, Brandon felt certain that modern medicine was well equipped to deal with this little bug. His ideas were challenged however when after running a battery of tests, the doctor informed him that his wound was infected with MRSA, a strain of Staph-aureus resistant to all commonly used beta-lactam antibiotics. A long battle with the infection cost him dearly in his professional life. Brandon however is not an isolated case. According to CDC reports there were 80,000 invasive MRSA infections and 11,285 related deaths in 2011.
A report in The Guardian quoted Dame Sally Davies; England’s Chief Medical Officer, warning us that we might face a return to the dark ages of life-threatening surgery unless we can preserve the infection-killing powers of antibiotics. Her comments were prompted by a Public Health England (PHE) report stating that 3 million common surgical procedures, including caesarean sections and hip replacements, could be hazardous in a future where hospital-acquired infections have become resistant to the common antibiotics used to treat them.
Mutations, acquisition of genetic material or alteration of gene expression in rapidly proliferating bacteria results in a genetically diverse population of progeny. In a culture medium inoculated with antibiotics, which is what the modern world has turned into, “survival of the fittest” ensures that antibiotic resistant strains thrive. Hence it comes as no surprise that infections with these “Superbugs” is on the rise.
Although it is the genetically evolving bacterial species which are responsible for this new survival trait, we humans are to blame for creating the right environment to push these species into the process of natural selection. The overuse of antibiotics, especially those that are broad spectrum, has sped up the pace of this evolutionary process in bacteria. A PHE survey in 2017 showed that 38% of patients still expect an antibiotic from a doctor’s surgery, NHS walk-in center or GP out-of-hours service when they visit with a cough, flu or a throat, ear, sinus or chest infection although it may have no role in the treatment of viral infections.
The development of newer antibiotics is being fast outpaced by emergence of resistant strains and has led to a renewed interest in a therapy long forgotten in this era of antibiotics. The discovery of bacteriophage by Frederick Twort in 1915 and subsequent research led to the popularity of phage-therapy for bacterial infections in the early twentieth century. The initial enthusiasm however subsided in most of the western world after World War II, with the exception of the then USSR. While the western medicine developed newer antibiotics, Soviet Union and Eastern Europe continued the active use of these bacterial viruses to treat bacterial infections ranging from the mundane to the maleficent.
A phage is a virus that infects a cell by injecting and incorporating its own genome into the DNA of the host cells, in this case a bacterium. It uses the bacterial cell as a production house for its own progeny which continue the cycle of infection and replication in other bacterial cells. This unique virus however is unable to infect human cells and hence has got a unique specificity for its target. The resistance to bacteriophages is counteracted by mutations in the phage DNA as both compete with one another in a Darwinian evolutionary duel. The only true beneficiary in this duel is being a patient with a bacterial infection. The practical uses of phages are many, including, but not limited to treatment of antibiotic resistant strains of bacteria, treatment of bacterial infections where antibiotic use is contraindicated
(eg. Drug allergies), Food and agriculture industry and possibly as probiotics. There has been a renewed interest in the use of Phage therapy for antibiotic resistant bacterial infections in the recent past due to the growing number of cases of antibiotics failure. Although the lack of “gold standard” Randomized controlled trials has led to the slowness in application of this unique therapy in the “Real World”. The rising incidence of the superbugs may however speed up the research in the near future and we might see a paradigm shift in our treatment modalities of infectious diseases. It might become a ray of light stalling our return to the pre-antibiotics “dark ages”.