The enemy of our bacterial enemy can indeed be our friend. In a new case report, doctors say they have managed to treat their patient’s long-lasting drug-resistant infection with the help of specially bred bacteriophages – viruses that infect bacteria. However, large clinical trials are likely to be needed to make these treatments widely used.
Viruses rob living cells of cells to make more of themselves. And just as there are viruses that specifically infect humans, plants and other organisms, there are some that have evolved to prey on bacteria. Shortly after scientists discovered the existence of the virus at the turn of the 20th century, they also learned about phages. By the late 1910s, some physicians were already trying to use phage as a potential cure for bacterial infections, which became known as phage therapy.
But by the 1940s, with the advent of the modern antibiotic era, phages had fallen out of favor for several reasons. The first antibiotics to be widely used were broad-spectrum, able to quickly cure many different types of infections and relatively easily spread in mass production. Phages, on the other hand, were more difficult to clean and store, and their benefits were often inconsistent.
Scientists and doctors in some parts of the world where antibiotics were less available, such as Eastern Europe and India, nevertheless continued to research and use phage therapy. And in the end, it became clear that antibiotics were not as miraculous as we had hoped. Bacteria have developed resistance to these drugs over time, to the point where we now see infections that cannot be treated at all. So, understandably, scientists have expressed renewed interest in phages as a weapon against bacteria in recent decades.
This new report, Published On Tuesday in the journal Nature Communications, details of a 30-year-old woman in Belgium who had lived with a superbacterial infection for nearly two years. The woman was seriously injured during a bomb attack in Brussels in March 2016, and after an operation to repair a broken femur, she contracted a number of bacterial and fungal infections. Four months after continuing antibiotic treatment, doctors confirmed she was carrying the strain Klebsiella pneumoniae which was extremely resistant to antibiotics. The infection also appeared to have become part of the biofilm, a resistant, sticky layer of bacterial colonies that shrinks, making it difficult for antibiotics to succeed. The infection made it impossible to completely heal the wound full of pus and injuries.
By November 2016, after months of unsuccessful attempts to clear the K. pneumoniae infection, her doctors had cleared the use of phage therapy with the hospital’s ethics committee. The specially selected phages were provided by the George Eliava Institute of Bacteriophages, Microbiology and Virology, in Tbilisi, Georgia. But her treating physicians disagreed about the best course of action for treatment, and the phase therapy was postponed while she continued to take antibiotics.
Finally, in February 2018, fearing a “therapeutic dead end,” her doctors went ahead and decided to use the phages. The phages were given to her after a surgical procedure to remove dead tissue from the wound and to replace the frame that kept her broken bone stable. She was also given bone grafts that had been infused with antibiotics. Over the next six days, she would receive the phages through a catheter. Midway through, she was also switched to a newer antibiotic thought to be more effective against the superbug.
By day two of the combination phage and antibiotic treatment, the infection at last seemed to be retreating. And by the three-month mark, the infection had fully cleared and the woman was taken off antibiotics altogether. Three years in, she’s now able to regularly participate in sporting events like cycling, though she does require a crutch for aid at times. Most importantly, “there are no signs of recurrent K. pneumoniae infection,” the doctors wrote.
The findings appear to show that phages can be used in sync with antibiotics to treat otherwise incurable infections, though they may also be useful on their own. In this case, the phages were “pre-adapted” to the infection, meaning that the phages were repeatedly exposed to the bacteria in a petri dish, each time picking up mutations designed to make them even deadlier. This proces It is believed to improve their power and reduce the risk of bacteria learning how to outwit phages.
While phage therapy is experiencing a resurgence in medicine, there are still many questions about what is the best way to use it. Even experts excited about the potential of phages say more research is needed to ensure their widespread acceptance by doctors.
“Indeed, the future of phage therapy rests on abundant data from clinical trials,” said Paul Turner, a non-research professor of ecology and evolutionary biology at Yale University. said Livescience.
they already exist ongoing trials phages that test them in the treatment of resistant superbacterial infections, such as those that tend to affect people with diseases such as cystic fibrosis.