This health threat could kill millions more than COVID-19. A solution may be in our sewage


Fishing for samples from a raw sewage pond isn’t terribly pleasant work, but Ruby Lin hopes what she collects here will help avert a medical catastrophe.Key points:Phage therapy involves the use of specific viruses to target bacterial infectionsSome doctors hope it will play a major role in stopping deaths caused by antibiotic-resistant bacteriaThere have been promising results in clinical trials in Sydney, but the therapy has its drawbacksWhile one virus claims thousands of lives across the globe daily, it’s hoped millions more could eventually be saved by other viruses.Some of them are lurking in this sewage system at a Sydney nursing home.Human waste is a rich source of organisms called bacteriophages — known as “hunt and kill viruses” for their ability to bind to bacteria and destroy them.Increasingly, the viruses are of interest to doctors concerned about antibiotic resistance — a health threat predicted to cause 10 million deaths per year by 2050. Phages are commonly found in sewage.(ABC News: Brendan Esposito)”We have a large population of elderly people and a lot of them are on antibiotics,” Dr Ruby Lin said as she sealed another sample from the pond inside a glass bottle.”You will be able to extract a lot of bacteriophage from this sample.”Our latest study has shown we are able to safely administer intravenously these phages to patients who are not responding to specific types of antibiotics.”Phages are viruses that live naturally in substance such as soil and sewage.They bind to bacteria, infect and kill them by injecting their DNA.As superbugs become resistant to antibiotics, phages are seen as a promising alternative for patients who have run out of options.On average, 290 people die in Australia each year as a result of infections from eight drug-resistant bacteria, according to the Organisation for Economic Co-operation and Development (OECD).Last year, a report from the Australian Commission on Safety and Quality in Healthcare found antibiotics were still being overprescribed and misused. That was causing dangerous bacteria to grow increasingly resistant to common medicines.The report said there was little evidence that antibiotic resistance was diminishing and that it posed an ongoing and ‘substantial’ risk to patient safety. Dr Khalid and Dr Lin hope their research will aid in the fight against superbugs.(ABC News: Brendan Esposito)Little girl’s ‘miracle’ cureThe Westmead Institute for Medical Research (WIMR) laboratory that Dr Lin is part of is the first in Australia to run a clinical trial of phage therapy for people with superbug infections.Dhanvi is one of 13 patients who received the treatment and her mother described the result as a miracle.She was an active girl with a love of karate and swimming before being seriously injured in a car accident on an overseas holiday in January last year.She had multiple fractures and wounds on her leg that would not heal.”She told us she had a lot of pain in her left ankle and couldn’t walk at all,” her mother, Deyasini, said. Dhanvi’s leg was severely injured in a car crash.(Supplied)She was referred to see WIMR professor Jon Iredell to treat a serious bacterial infection that had taken hold in her leg.”These things are hard to treat at the best of times, but when it is infected with something that’s antibiotic-resistant, you get to the point where the infection is virtually untreatable,” he said.”Inevitably, there’s a risk of losing that leg and that’s what she was facing.”Once doctors knew exactly what kind of infection she had, they did a worldwide search and found a phage that could match and potentially kill the bacteria.”The doctor was really hopeful that if it worked so well in the lab environment, they thought it will work when they give it to my daughter,” Deyasini said.The little girl was admitted to Westmead Hospital for two weeks so she could be monitored for any side effects while the treated phage was given intravenously.But she sailed through the treatment without any problems.”Within just a few months, she was able to walk,” Deyasini said.”I think it’s a miracle.” Dhanvi was able to walk again just a few months after phage treatment.(ABC News: Brendan Esposito)’A race against time’As well as chronic infections, phages could help patients with life-threatening infections that are not responding to antibiotics.When Australian scientist Jeremy Barr was working in San Diego, he was involved in the first case of phage therapy for an antibiotic-resistant infection in the United States.The patient, Tom Patterson, had picked up the infection while in Egypt.After suffering septic shock and organ failure, the 69-year-old was placed in a coma.Three days after receiving the phage therapy, he woke up.”The patient made a really miraculous recovery,” Dr Barr said.”A lot of the time, these patients have days, if not weeks, to fight back and kill the bacterial infection.”Dr Barr said the challenge was finding a phage that matched the patient’s particular bacteria before it was too late.”So for us researchers trying to implement phage therapy, it’s really a race against time before that pathogen wins against the patient’s own immune system.”Running out of antibiotics that work was a “really terrifying prospect”, he said.”The resistance is becoming more and more severe so we started to look for alternative therapies and phage therapies is one of those options.”Turning back the clockPhage therapy has actually been around for 100 years.It was overtaken by the use of antibiotics in the 1940s, but is still routinely used in eastern Europe. Dr Lin and Dr Khalid conduct research on bacteriophages in their Westmead Hospital laboratory.(ABC News: Jerry Rickard)One of the drawbacks of phage therapy is that doctors need to find the specific phage that will work to kill off the particular bacteria a patient has.Once the phage has been isolated, it needs to go through a “cleaning process” to ensure it does not release any toxins that might be dangerous for the patient.Despite the complexities, ANU infectious diseases expert Peter Collignon believes it’s worth pursuing.”The limitations are that because there’s lots of phages, they won’t work against every strain or even multiple strains,” Professor Collignon said.”I am not sure it’s a silver bullet but it has got potential.”For now, phage therapy is only available in Australia through clinical trials, like the one at Westmead.It is unlikely to be used more widely in hospitals and clinics until the results of these current studies are known.That is several years away.Libraries could speed things upSome Australians, like Frances Caratozzolo, are taking matters into their own hands to get phage treatment now.The Melbourne fitness instructor is both self-injecting and drinking phages that she ordered from overseas.She hopes they will help with a hip infection that has been refusing to heal. “I spent thousands of dollars for my leg and nothing worked, so I thought this is the last resort,” she said.After having a range of tests including an MRI, she turned to a facility in Georgia, Europe, that could ship the phages to her if she provided a sample of the bacteria strain.”So far, so good. I have seen slight changes and it’s still in the early stages,” she said. Sample collection has its downsides, but the researchers hope it will pay off.(ABC News: Brendan Esposito)Researchers are also working on so-called phage libraries, which could speed up access here.That involves labs building up banks of phages for particular bacterial infections, Professor Barr said.”For instance, if the patient came in with a Staphylococcus aureus [golden staph] infection, if we had enough phages that targeted all of those, we could quickly select and isolate the ones that worked and build a personalised medicine model for the use of phages,” he said.”It’s extremely exciting.”*surname withheld at the request of the family.

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