20 | New Scientist | 29 January 2022
News
HealthMORE than a million people
died from antibiotic-resistant
infections across the world in
2019, according to a
comprehensive global survey.
Bacteria that are resistant to
antibiotics are considered one of
the biggest threats facing modern
medicine. Overuse of such drugs
has led to resistance becoming
more widespread, raising the
prospect that common infections,
such as sepsis and pneumonia,
will become harder to treat.
Mohsen Naghavi at the University
of Washington in Seattle and hiscolleagues devised a model to
estimate how many people died in
2019 from bacterial infections that
could have been treated were it not
for antimicrobial resistance (AMR).
The model was based on the
medical records of 471 million
people with antibiotic-resistant
infections from 204 countries,
using regional patterns to calculate
figures for nations with little data.
The researchers found that about
1.3 million global deaths could be
directly attributed to AMR. A further
3.65 million deaths involved people
who had diseases that showedsome form of AMR (The Lancet,
doi.org/gn7jdx). “We can’t say
for certain that these deaths
were due to antimicrobial
resistance, but some mayhave been,” says Naghavi.
If both groups are included, it
would have made AMR the third
leading cause of death globally
in 2019 behind ischaemic heartattacks and strokes. Even the
more conservative estimate would
mean that AMR killed more people
that year than AIDS, which was
responsible for 680,000 deaths,
and malaria, which killed
627,000 people.
“The stark reality of these figures
points to the critical and urgent
need to increase resources for the
basics of infection control. In many
places, this means water, sanitation,
hygiene,” says Clare Chandler at
the London School of Hygiene &
Tropical Medicine. ❚Antibiotic resistance killed more than AIDS in 2019
“ The deaths point to the
urgent need to increase
resources for the basics
of infection control”Jason Arunn MurugesuTHERAPIES that use bacteria-
killing viruses known as phages
to treat antibiotic-resistant
infections are starting to take off
in Belgium, thanks to a regulatory
system that makes it easier for
doctors to prescribe them.
“Phage therapy is indeed
getting more common, at least in
Belgium,” says Jean-Paul Pirnay at
the Queen Astrid Military Hospital
in Brussels. “We have coordinated
phage treatments in just over
100 patients.” Pirnay says his team
plans to analyse all these cases
and publish the results soon.
“I would say there is a clinical
improvement in about 70 per cent
of cases,” he says. “Mind you, most
of these patients were desperate
after antibiotics failed.”
Pirnay and his colleagues have
already described one early case in
detail. In March 2016, a 30-year-old
woman suffered severe injuries to
her leg in a suicide bombing at
Brussels airport. Despite being
given antibiotics when admitted
to the Erasme Hospital in Belgium,
the wounds became infected,
preventing them from healing.After several months, antibiotic
treatment had caused side effects,
but failed to clear the infection.
The main culprit was a strain
of a bacterium called Klebsiella
pneumoniae that is resistant
to almost all drugs.
One of the doctors, Anaïs
Eskenazi, decided to try phage
therapy. A sample of the bacterium
was sent to the Eliava Institute
in Tbilisi, Georgia, to find a phage
that could kill it. The institute has
been using phage therapy to treat
infections since the 1920s.
After finding such a phage,the institute evolved the virus to
make it even better at killing the
bacterium. The therapy was ready
to go ahead by November 2016,
but was put on hold because some
doctors were concerned about
safety and efficacy.
“At the time, there was very
little scientific literature about the
use of phage except in countries
where phage therapy has been
used for a long time, like Georgia
and Poland,” says Eskenazi, now
at the Cayenne Hospital Center
in French Guiana.
By February 2018, the womanMedicineMichael Le PageBIOPHOTO^ ASS
OCIATES
/SCIENCE
PHOT
O^ LIBRAR
YBelgium ramps up use of superbug-
killing viruses to defeat infections
Phages (in green)
attached to a fragment
of a bacterial cell wallstill wasn’t improving. She was
finally treated with the phage in
combination with antibiotics.
Within weeks, her condition
improved, and her badly
damaged femur finally began to
heal. She is now able to walk again,
usually with crutches (Nature
Communications, doi.org/hdbt).
Despite the success, there are
obstacles to using phage therapy
more widely. The viruses used
are specific to particular bacteria,
and those bacteria can evolve
resistance, says Ben Temperton
at the University of Exeter, UK.
There are regulatory issues
too. At the time the woman was
treated, Eskenazi had to get special
approval to try phage therapy.
However, in 2019, the Federal
Agency for Medicines and Health
Products in Belgium introduced
a system specifically designed for
phage therapy, making it much
easier for doctors to try it and
leading to a spike in its use. ❚