Global Health in Action Against a Superbug

The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug: A Memoir By Steffanie Strathdee, Thomas Patterson, and Teresa Barker (contributor)

New York: Hachette Books; 2019 352 pages; hardcover $36.50; e-book $14.99; audiobook $25.98 ISBN-10: 0316418080 ISBN-13: 978-0316418089

The field of global health typically changes through slow progressive movement. Each research study adds another element to the dynamic dimension of the problem. For example, people cannot simply be given access to water; research suggests that the project to bring clean water to those who do not have it must be community led, must include education on water safety and waterborne diseases, and must be sustainable and maintainable. But, every now and then, there is a breakthrough in global health that moves beyond typical research and has life-changing implications. The Perfect Predator is a book about that situation exactly—a rare case of innovation that might change the course of global health knowledge and uphold the foundational goal of saving more lives.

Steffanie Strathdee writes about how her husband, Thomas Patterson, contracts a multidrug-resistant bacterial infection while they are traveling abroad. The story begins by describing a pretty normal adventure—the husband and wife were in Egypt exploring the pyramids—but what happens next is a downward spiral of health-related events. Tom began to show symptoms of food poisoning, which many of us get when we travel, but his symptoms significantly worsened, which Steffanie, an epidemiologist and global health researcher, recognized. He was rushed to a clinic in Egypt; however, all parties started to realize that the scant access to medical care would not be enough to alleviate Tom’s illness. Steffanie and Tom were medevacked from Egypt to Goethe University Hospital in Germany and eventually to the intensive care unit at University of California at San Diego Thornton Hospital, where Tom would spend months.

ACINETOBACTER BAUMANNII

The book describes Tom’s descent into septic shock and near death, as the bacterial invader, Acinetobacter baumannii slowly started to colonize his body. Strathdee is a global health scientist writing about a personal adventure from the perspective of a researcher. Her husband began antibiotic treatment, but it failed to eliminate the superbug from his body, as the bacteria had become fully resistant to all antibiotics. As he experienced several episodes of septic shock, reality started to creep in. Strathdee asked, “Tom is dying. He is slowly slipping away. Am I right?” One of the primary physicians on the case answered, “I think so, yes.”^(p135–136) After a moment of personal sorrow, Steffanie switched gears and transformed from Patterson’s wife into Dr. Strathdee, global health epidemiologist. She began hunting for answers, alternative therapies, and solutions to multidrug-resistant pathogens on PubMed. She came across an interesting therapy that was used throughout the past century in various parts of the world but never fully surfaced to make its rightful claim in Western medicine: phage therapy, an underused tool for fighting bacterial infections that was overshadowed by the development of antibiotics in the mid-20th century.

Bacteriophages (phages) are viruses that devour bacteria by injecting viral DNA into them; this lyses the bacteria and releases hundreds of progeny phages. The idea surrounding phage therapy is that these viruses are able to target specific bacteria, like A. baumannii, and can therefore be used to cure bacterial infections. At the time of publication, phage therapy was being researched in the United States but had not been used to treat a systemic superbug infection. The most difficult part of this therapy is that phages essentially need to match the bacteria, so a proverbial Easter egg hunt needs to take place to find them. Phages usually can be found in less than desirable places, like sewage systems, swamps, soil, and other places that bacteria typically exist.

Strathdee contacted experts throughout the world, hoping that they would be able to aid in the hunt. She was successful in finding a few labs that had some phages specific to A. baumannii. However, to employ an experimental medical treatment, the US Food and Drug Administration needs to approve it. There are two ways to obtain approval: either the treatment must undergo clinical trials—the traditional route—or it must involve an eIND (experimental investigational new drug), which can be used if all conventional treatments have failed. Strathdee and her colleagues at the University of California, San Diego applied for and received approval to use phages to treat Tom’s case. After sourcing several phages throughout the country from various phage research labs, the novel treatment was ready, and just in the nick of time. Phage cocktails were injected into Tom through his abdominal catheters and then intravenously. Within just a few days, Tom awoke from a deep coma and began his turnaround, leaping off death’s platform back into life.

PHAGE THERAPY

It was difficult reading this book because most of us have traveled worldwide; in fact, many of us have even been to Egypt with our loved ones, wandering around exploring the ancient beauty of the pyramids. What happened to Strathdee and Patterson was unfortunate, occurring only by chance; moreover, the risk of contracting multidrug-resistant bacteria is increasing. The use of antibiotics in livestock and humans is widespread, and bacteria have rapidly evolved to acquire multidrug-resistant genes that render antibiotics useless.^1,2 In fact, the World Health Organization classified multidrug-resistant bacteria as one of the most important problems facing public health today.¹ Some of the most serious bacterial pathogens are commonly classified under the acronym ESKAPE, which stands for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.^2,3 Tom contracted the “A” in the lethal ESKAPE acronym.

The Perfect Predator portrays how quickly someone can transition from being seemingly healthy to deathly ill, despite receiving all available medical options in a top rate hospital. Using bacteriophages is currently an underexplored and underused tool that may become a widespread weapon against multidrug-resistant bacterial pathogens. Patterson’s healing capacity and ascent back to life represents a successful case using a potential life-changing therapy. Fortunately, this therapy is being researched now; the first ever phage therapy center—the Center for Innovative Phage Applications and Therapeutics at the University of California, San Diego—is in the process of moving treatment to clinical trials.

The story of a woman fighting for her husband’s life is interesting in and of itself, but this book is so much more than that. It was written by a scientist who used her public health training to discover a solution to a problem; it just so happens that the solution she found may be an answer to one of the most urgent health problems in the world.