Last month, the FDA reported that two patients fell ill after receiving fecal transplants contaminated with a drug-resistant bacteria. One patient died. We know how this happened, and perhaps how it could have been prevented. This unique case, tragic as it is, also encapsulates our losing battle against drug-resistant bacteria.
Before the transplant, the patients were suffering from an infection of Clostridium difficile, a rod-shaped bacteria that simply can’t take a hint. When doctors prescribe typical antibiotics, a lot of C. difficile's fellow gut germs take that as a sign of "last call," and head home. Like an impolite guest, however, C. difficile doesn’t respond to social cues. Instead, it sees all the extra space and makes itself at home, feasts on your leftovers, and causes uncontrollable diarrhea.
Experts view antibiotic overuse as a leading factor in the continued rise of C. difficile and other superbugs. Once infected, these people encountered a second element to this ongoing war: antibiotic futility. Only a few antibiotics seem to work against C. difficile and patients still likely to relapse. Just when you think C. difficile is getting up from your couch and putting on its coat to leave, it asks for some clean sheets and a copy of your lease.
At this point, resigned, you might decide to invite your polite friends back over, to balance the vibe back out and restore the balance of "good" bacteria in your intestines. That’s why many patients turn to fecal microbiota transplants, or FMT.
Unfortunately, that’s where things went wrong in this case. The trial researchers did not screen for superbugs. Diagnosing and detecting some drug-resistant bacteria is possible, but it takes several days. And that inability to detect specific types of superbugs quickly makes the problem worse. Doctors end up prescribing antibiotics that won't work, which makes people sicker and allows the drug-resistant bacteria more time to evolve. In fact, the NIH has a $20 million competition going on for this very specific research area "seeking innovative, rapid point-of-care laboratory diagnostic tests to combat the development and spread of drug resistant bacteria."
The war against superbugs is being fought in three main battlegrounds: stopping antibiotic overuse, finding more effective antibiotics, and addressing the clinical need for rapid diagnostics. The clock is ticking, and hopefully there will be new breakthroughs soon.