This story reads like science fiction, but it’s not. If you didn’t know that multidrug-resistant bacteria will kill someone every 3 seconds by 2050, you’re not alone. Tom and I were blindsided when he went from being a supremely hardy guy to one who was fighting for his life against the deadliest superbug on the planet. For me, as an infectious disease epidemiologist, my professional and personal lives collided, and I took it personally.
This book isn't just our story; it’s a cautionary tale about the world we now live in, a world on the verge of a post-antibiotic era where a small scrape or a routine surgery could end up being fatal. Find out how we enlisted the help of strangers around the globe to resurrect a hundred-year-old forgotten cure that now holds promise as a potential solution to combat the global superbug crisis.
Steffanie Strathdee, Ph.D., 2019
Every year, a chill wind blows colder, signaling that a stunning twentieth century success could someday bring “antibiotic winter.” And even if we believe science will check the global threat, nothing focuses the mind like a harrowing story. One man’s battle with Acinetobacter baumannii presents with a final, surprising twist. His 11th-hour rescue was so dramatic that a famous Hollywood person has now optioned his story for a major motion picture.
So much for my tease for The Perfect Predator—A Scientist’s Race to Save Her Husband from a Deadly Superbug. Has any previous book about bacteriology inflamed a similar response? Well, yes. Following its 1931 release, the movie based on Sinclair Lewis’s Arrowsmith earned four Academy Award nominations, including Best Picture.
In Lewis’s story, however, an antiserum halted a firestorm of plague. For Dr. Tom Patterson, salvation equaled multiple infusions of bacteriophage specifically crafted to kill his resistant, promiscuous bug.† No previous human had ever received this novel therapy, much less a patient who had already spent 100 days facing death.
The Perfect Predator’s coauthors could easily be us. Patterson is a professor of psychiatry at the University of California, San Diego (UCSD), whose research has ranged from HIV/AIDS prevention to rehabilitating patients with dementia—Stephanie Strathdee, his epidemiologist wife, is UCSD’s Associate Dean of Global Health Sciences. The two were vacationing in Egypt when Patterson first suffered gallstone pancreatitis, a condition in which gut bacteria sometimes breach the biliary tree. Roughly a week later, after he was flown by emergency transport from a clinic in Luxor to a university hospital in Germany, a football-sized pseudocyst in Patterson’s pancreas grew a strain of A. baumannii that was nearly impervious to treatment. After Patterson was once again med-evac’ed to Thornton Hospital at UCSD, his stowaways lost their final shreds of sensitivity.
That’s when Strathdee started scouring the internet and stumbled across reports of “Trojan horse” viruses that killed dangerous bacteria. “Might one or more phages destroy Tom’s deadly invaders?” she wondered. What followed next was a heroic effort to find, test, and purify the sci-fi–like creatures (in the book, Strathdee likens phages to “… tiny alien spaceships with long spindly legs, not unlike the Star Wars Imperial walker Cameron [her son] used to make from Legos”) by a team including Carl Merril, a retired, veteran NIH scientist‡; creators of customized phage at Texas A&M and a navy laboratory in Maryland; and a San Diego start-up called AmpliPhi Biosciences. Taking the lead at UCSD was Strathdee’s long-time colleague Dr. Robert “Chip” Schooley, an infectious diseases specialist whose career in research had already spanned HIV immunology, treatments for herpes, and the development of drugs for hepatitis C. In addition, Schooley has studied the delivery and use of lifesaving antiretrovirals in Africa. Today, he also serves as editor in chief of Clinical Infectious Diseases and, with Strathdee, codirects the recently created UCSD center called I-PATH, which stands for Innovative Phage Applications and Therapeutics.
Now for a quick primer for those who are rusty on phage. First discovered in 1917,§ the tiny subunits are ubiquitous, their numbers exceeding all other organisms combined. Bacteriophage not only inhabit seawater, sewage, and all other sites on our planet but also abound in our digestive, respiratory, and reproductive tracts. They act in myriad ways. Their genetic material can remain dormant or unleash potent bacterial toxins (cholera and diphtheria, for example, are two diseases turned lethal by phage). Most importantly, lytic phage like the Ninja fighters flown to UCSD (see following text) can invade bacteria, amplify their viral kin, then burst out and ablate their bacterial sancta, repeating the process ad infinitum. The only glitch? The superheroes can also wilt if their quarry deletes genes encoding their attachment. And this, of course, is just one of several clever maneuvers by which bacteria deflect their bellicose foes.
Back to the book which continues to fly off the shelf. Since its publication in early 2019, reviewers have hailed The Perfect Predator with accolades such as “a fascinating and terrifying peek into the devastating consequences of antibiotic misuse…” (Scientific American), “[a] gripping and intriguing medical thriller…” (Publishers Weekly starred review), and “[one of the] best health and science books to read this summer” [STAT News]. Add my name to its fans. Having previously worked with Strathdee on a global health committee for the University of California, I knew she was smart, funny, and tenacious. How much? To find out, just head to your closest bookstore, library, or—in the not-too-distant future—neighborhood theater.
Oh, and one more thing: If you’re looking for a gift for a young person currently considering a career in science or medicine, this is the book to buy. What Sinclair Lewis’s Arrowsmith, Paul de Kruif’s Microbe Hunters, Hans Zinsser’s Rats, Lice, and History, and Robert Desowitz’s New Guinea Tapeworms and Jewish Grandmothers did for earlier generations of curious kids, The Perfect Predator could do for their twenty-first century counterparts. Thanks to a cowriter named Teresa Barker, the book is fast paced, smart, and hip. Finally, it also features mystic reveries from some dark, stygian cavern in the mind of its ultimate protagonist, the patient himself. And then, miracle of miracles, Patterson comes back to life! No wonder Hollywood instantly inked a deal.
Acinetobacter baumannii is an increasingly important nosocomial pathogen that readily acquires antibiotic resistance by several means including transposons that facilitate horizontal gene transfers from other bacteria.
Merril spent most of his long career studying bacteriophage and eventually became the chief of biochemical genetics at an NIH laboratory. He was always interested in bacteriophages as human therapeutics.
Although another scientist reported antibacterial activity by a “filterable agent” in India’s Ganges and Yamuna rivers as early as 1896, Félix d’Hérelle, a French-Canadian microbiologist, is credited with the discovery and earliest use of bacteriophage as a medical therapeutic. In 1917, d’Hérelle reported an “invisible, antagonistic microbe of the dysentery bacillus” and immediately understood that a virus was parasitizing the bacterium.
This interview was conducted by phone on September 10, 2019 and was later edited for clarity and length.
Strathdee S, Patterson T, 2019. The Perfect Predator—A Scientist’s Race to Save Her Husband from a Deadly Superbug. New York, NY: Hachette Books.
Schooley RT 2017. Development and use of personalized bacteriophage-based therapeutic cocktails to treat a patient with a disseminated resistant Acinetobacter baumannii infection. Antimicrob Agents Chemother 61: e00954–17.
Law N 2019. Successful adjunctive use of bacteriophage therapy for treatment of multidrug-resistant Pseudomonas aeruginosa infection in a cystic fibrosis patient. Infection 47: 665–668.