News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

San Diego University Researchers Believe Bacteriophages May Be the Future of Eradicating Multi-Drug Resistant Superbugs

Clinical laboratories and microbiologists may soon have new powerful tools for fighting antimicrobial resistant bacteria that saves lives

Superbugs—microbes that have developed multidrug resistance—continue to cause problems for clinical laboratories and hospital antibiotic stewardship programs around the world. Now, scientists at San Diego State University (SDSU) believe that bacteriophages (phages) could provide a solution for dealing with multi-drug resistant superbugs.

Phages are miniscule, tripod-looking viruses that are genetically programmed to locate, attack, and eradicate a specific kind of pathogen. These microscopic creatures have saved lives and are being touted as a potential solution to superbugs, which are strains of bacteria, viruses, parasites, and fungi that are resistant to most antibiotics and other treatments utilized to counteract infections.

“These multi-drug-resistant superbugs can cause chronic infections in individuals for months to years to sometimes decades,” Dwayne Roach, PhD, Assistant Professor of Bacteriophages, Infectious Disease, and Immunology at SDSU told CNN. “It’s ridiculous just how virulent some of these bacteria get over time.”

Labs across the country are conducting research on phages in eradicating superbugs. Roach’s lab is currently probing the body’s immune response to phages and developing purification techniques to prepare phage samples for intravenous use in patients.

“There are a lot of approaches right now that are happening in parallel,” said Dwayne Roach, PhD (above), Assistant Professor of Bacteriophages, Infectious Disease, and Immunology at San Diego State University (SDSU), in a CNN interview. “Do we engineer phages? Do we make a phage cocktail, and then how big is the cocktail? Is it two phages or 12 phages? Should phages be inhaled, applied topically, or injected intravenously? There’s a lot of work underway on exactly how to best do this.” Clinical laboratories that test for bacterial infections may play a key role in diagnosis and treatment involving bacteriophages. (Photo copyright: San Diego State University.)

Building Libraries of Phages

When certain a bacterial species or its genotypes needs to be annihilated, a collection of phages can be created to attack it via methods that enter and weaken the bacterial cell. The bacteria will attempt to counter the intrusion by employing evasive actions, such as shedding outer skins to eliminate the docking ports utilized by the phages. These maneuvers can cause the bacteria to lose their antibiotic resistance, making them vulnerable to destruction. 

Some research labs are developing libraries of phages, accumulating strains found in nature in prime breeding grounds for bacteria to locate the correct phage for a particular infection. Other labs, however, are speeding up the process by producing phages in the lab.

“Rather than just sourcing new phages from the environment, we have a bioreactor that in real time creates billions upon billions of phages,” Anthony Maresso, PhD, Associate Professor at Baylor College of Medicine in Houston told CNN. “Most of those phages won’t be active against the drug-resistant bacteria, but at some point, there will be a rare variant that has been trained, so to speak, to attack the resistant bacteria, and we’ll add that to our arsenal. It’s a next-generation approach on phage libraries.”

Maresso and his team published their findings in the journal Clinical Infectious Diseases titled, “A Retrospective, Observational Study of 12 Cases of Expanded-Access Customized Phage Therapy: Production, Characteristics, and Clinical Outcomes.”

For the Baylor study, 12 patients were treated with phages customized to each individual’s unique bacterial profile. The antibiotic-resistant bacteria were exterminated in five of the patients, while several others showed improvement.

Clinical trials are currently being executed to test the effectiveness of phages against a variety of chronic health conditions, including:

Using a phage cocktail could be used to treat a superbug outbreak in real time, while preventing a patient from a future infection of the same superbug. 

“The issue is that when patients have infections with these drug-resistant bacteria, they can still carry that organism in or on their bodies even after treatment,” Maroya Walters, PhD, epidemiologist at the federal Centers for Disease Control and Prevention (CDC) told CNN.

“They don’t show any signs or symptoms of illness, but they can get infections again, and they can also transmit the bacteria to other people,” she added.

The colorized transmission electron micrograph above shows numerous phages attached to a bacterial cell wall. Phages are known for their unique structures, which resemble a cross between NASA’s Apollo lunar lander and an arthropod. (Caption and photo copyright: Berkeley Lab.)

More Studies are Needed

According to CDC data, more than 2.8 million antimicrobial-resistant (AMR) infections occur annually in the United States. More than 35,000 people in the country will die as a result of these infections.

In addition, AMR infections are a huge global threat, associated with nearly five million deaths worldwide in 2019. Resistant infections can be extremely difficult and sometimes impossible to treat.

“It’s estimated that by 2050, 10 million people per year—that’s one person every three seconds—is going to be dying from a superbug infection,” epidemiologist Steffanie Strathdee, PhD, Associate Dean of Global Health Services and co-director at the Center for Innovative Phage Applications and Therapeutics (IPATH) at the UC San Diego School of Medicine, told CNN.

The CDC’s 2019 report on bacteria and fungi antimicrobial resistant threats named five pathogens as urgent threats:

More research is needed before phages can be used clinically to treat superbugs. But if phages prove to be useful in fighting antibiotic-resistant bacteria, microbiologists and their clinical laboratories may soon have new tools to help protect patients from these deadly pathogens.

—JP Schlingman

Related Information:

Superbug Crisis Threatens to Kill 10 Million Per Year by 2050. Scientists May Have a Solution

About Antimicrobial Resistance

2019 AR Threats Report


Why Antibiotics Fail, and How We Can Do Better

A Retrospective, Observational Study of 12 Cases of Expanded-Access Customized Phage Therapy: Production, Characteristics, and Clinical Outcomes

Cataloging Nature’s Hidden Arsenal: Viruses That Infect Bacteria

UCSB Researchers Discover Superior Culture Medium for Bacterial Testing, along with New Insights into Antimicrobial Resistance

Microbial Surveillance Study Snares Patients Entering Michigan Hospitals with Drug-Resistant Bacteria on Their Hands

Thorough hand-washing protocols aren’t just for healthcare professionals anymore. Patients also need to be educated to prevent hospital-acquired infections

Microbiologists and clinical laboratory managers will be particularly interested to learn that patients are bringing deadly organisms into hospitals on their hands. That’s the conclusion of a University of Michigan (UM) study which found that as patients enter and move throughout hospitals, they deposit and spread multi-drug resistant organisms, or MDROs on clinical surfaces. When those surfaces are not properly decontaminated, the bacterial contamination spreads on contact.

This finding has implications for the nosocomial infection teams in hospitals that include microbiologists and clinical laboratories. After all, every day there is a large flow of walk-in patients and visitors who come in contact with dozens of surfaces. The potential for contamination with multi-drug resistant organisms is high.

Antibiotic-resistant bacteria have been the root cause of a marked increase in hospital-acquired infections (HAIs), which Dark Daily has covered extensively. That’s why healthcare professionals practice proper hand-washing protocols to help reduce the transmission of pathogens and curtail possible infections.

The UM study, however, suggests that patients also should be educated on proper hand hygiene to diminish the potential spread of bacteria, especially before making trips to the emergency room.

The UM researchers published their study in the Oxford Academic journal Clinical Infectious Diseases.

How to Kill a Superbug

Between February and July of 2017, UM researchers at two hospitals in Southeast Michigan tested 399 general medicine hospital patients for the presence of MDROs, also known as superbugs. They swabbed the palms, fingers, and around the nails of the patients’ dominant hands and the interior of both nostrils.

The researchers found that 14% of the patients tested positive for MDROs. In addition, nearly one third of high-touch objects and surfaces in the hospital rooms tested positive for superbugs as well.  

The hospital room surfaces that were swabbed for the presence of MDROs were:

  • Bed control/bed rail;
  • Call button/television remote;
  • Bedside tray table top;
  • Telephone;
  • Toilet seat; and
  • Bathroom door knob.

The research team specifically looked for:

Due to the overuse of antibiotics, these types of bacteria are often resistant to the drugs that were once used to kill them.

“Hand hygiene narrative has largely focused on physicians, nurses, and other frontline staff, and all the policies and performance measurements have centered on them, and rightfully so,” said Lona Mody, MD (above) in a press release. Mody is Professor of Internal Medicine at UM and one of the lead researchers for the study. “But our findings make an argument for addressing transmission of MDROs in a way that involves patients, too.”

Anatomy of a Hospital-Acquired Infection

The scientists tested patients and surfaces at different stages of their hospital stays. The samples were taken on the day of admission, days three and seven of the stays, and weekly thereafter until the patients were discharged.

The team found that 6% of the patients who did not have MDROs present at the beginning of their hospital stays tested positive for superbugs at later stages of their stays. Additionally, 20% of the tested objects and surfaces in the patients’ rooms had superbugs on them at later test stages that were not present earlier in the hospital stays.

“This study highlights the importance of hand washing and environmental cleaning, especially within a healthcare setting where patients’ immune systems are compromised,” noted Katherine Reyes, MD, Department of Infectious Diseases, Henry Ford Hospital, in the press release. “This step is crucial not only for healthcare providers, but also for patients and their families. Germs are on our hands; you do not need to see to believe it. And they travel. When these germs are not washed off, they pass easily from person to person and objects to person and make people sick.”

Patients included in the study had to be new admissions, on general medicine floors, and at least 18 years of age. Criteria that excluded individuals from participation in the research included:

  • Being in observation status, typically after a medical procedure;
  • Transfers from other hospitals;
  • Transfers from intensive care units;
  • Having cystic fibrosis (these patients have a higher likelihood of MDRO colonization);
  • Receiving end-of-life care; and
  • Non-English speaking.

Patients who were transferred to a room on a nonparticipating floor within the hospitals were immediately discharged from the study. 

Patients Travel Throughout Hospitals Spreading Germs

The presence of superbugs on patients or surfaces does not automatically translate to a patient getting sick with antibiotic-resistant bacteria. Only six of the patients in this study developed MRSA. However, all six of those individuals tested positive for the superbug either on their hands or on surfaces within their room. 

The researchers noted that hospital patients typically do not stay in their rooms. They are encouraged to walk throughout the hospital to speed up the recovery process, and often are transported to other areas of hospitals for medical tests and procedures. Patients also may be picking up superbugs from other patients and staff members, other hospital areas, and commonly-touched surfaces.

The UM researchers concluded in their study that “while the burden of preventing infections has largely been borne by [healthcare personnel], our study shows that patient hands are an important reservoir and play a crucial role in the transmission of pathogens in acute care hospitals. Thus, patient hand hygiene protocols should be implemented and tested for their ability to reduce environmental contamination, pathogen transmission, and healthcare-associated infections, as well as to increase meaningful patient engagement in infection prevention.”

“Infection prevention is everybody’s business,” stated Mody in the press release. “We are all in this together. No matter where you are, in a healthcare environment or not, this study is a good reminder to clean your hands often, using good techniques—especially before and after preparing food, before eating food, after using a toilet, and before and after caring for someone who is sick—to protect yourself and others.”

These research findings should prove to be valuable for infection control teams and microbiology laboratories in the nation’s hospitals and health systems, as well as independent clinical laboratories, urgent care centers, and retail healthcare clinics.

Learning more about the transmission of infectious agents from patient to patient and from surfaces to patients could aid in the development of new techniques and strategies to prevent superbugs from manifesting in medical environments.

—JP Schlingman

Related Information:

‘Superbugs’ Found on Many Hospital Patients’ Hands and What They Touch Most Often

Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms?

Unexpected Discovery of Source of Lethal, Antibiotic-Resistant Strain of E. Coli Could Lead to New Medical Laboratory Tests and Preventative Treatment

Lurking Below: NIH Study Reveals Surprising New Source of Antibiotic Resistance That Will Interest Microbiologists and Medical Laboratory Scientists

Pathologists and Clinical Laboratories to Play Critical Role in Developing New Tools to Fight Antibiotic ResistanceCould Proximity of Toilets to Sinks in Medical Intensive Care Units Contribute to Hospital-Acquired Infections?

Study Shows How Simple Changes in Reporting Medical Laboratory Test Results to Clinicians Improve Patient Safety and Reduce Inappropriate Use of Antibiotics

Researchers focused on whether different ways of reporting clinical laboratory test results would improve care for patients at low risk for developing urinary tract infections

Simple changes in how clinical laboratory tests are reported to clinicians can contribute to improved patient safety and a reduction in the inappropriate use of antibiotics. These were the conclusions of a recent study published in the Infectious Diseases Society of America’s (IDSA) peer-reviewed medical journal, Clinical Infectious Diseases (CID).

If the findings of this study can be duplicated in other settings, it can provide pathologists and medical laboratory scientists with another approach to improve the way clinicians utilize clinical laboratory tests so as to improve patient outcomes and reduce the associated cost of care. (more…)

John Hopkins Researchers Demonstrate Hydrogen Peroxide’s Effectiveness in Preventing HAIs, May Have Use in Clinical Pathology Laboratories

The study found that a Robotic vapor-dispersing device kills and prevents spread of Drug-Resistant Organisms in high-risk patients by 64%

There is a new technology for disinfecting healthcare facilities that is likely to be useful for clinical laboratories and anatomic pathology groups.

A team at Johns Hopkins University Hospital recently published a study about their institution’s use of hydrogen peroxide vapor to disinfect hospital rooms.

The study was conducted over two and one-half years and involved hospital rooms used by thousands of patients. The goal of this study was to verify the effectiveness of a new robot-like device, known as Bioquell Q-10. This system disperses a hydrogen peroxide vapor to disinfect hospital rooms and was described in a news release issued by Baltimore-based Johns Hopkins University Hospital. (more…)