'There was no other choice... Do or die,' says first Canadian in the country to try new infection treatment

An Ottawa-area woman has become the first in the country to test out a new kind of therapy for treatment-resistant infections that happen in some patients who receive hip or knee replacements.

Thea Turcotte, 79, was in the hospital with a life-threatening infection -- 15 surgeries over eight years had failed to clear the bacteria, and all antibiotics failed or caused her toxic side effects. Doctors told her they were running out of options. 

"It was very scary, very nerve-wracking," said Turcotte.

By the time Dr. Marisa Azad, an infectious disease specialist at the Ottawa Hospital, saw Turcotte, she was in a crisis, with the infection causing an abscess on her hip with pus pouring out.

"It was terrible," said Azad who is also a researcher at the Ottawa Hospital Research Institute.

"That's when I decided, you know, this is the end of the line here, we have to look at experimental therapies to try and save this poor woman's life," the doctor said.

Turcotte had to make a decision.

"There was no other choice, it was do or die," she said.

Phages are viruses that fight bacteria, long considered a fringe therapy, that have gained new and intense scientific interest because of rising rates of infections that can't be killed.

Azad pushed for an application to test phage therapy, gaining rare, federal permission for a one-patient use.

The phages were supplied by Winnipeg-based Cytophage, a biotechnology company specializing in bacteriophage therapy development.

Billions of phages were infused over two weeks into Turcotte's hip by IV.

Personalized medicine

"With each dose, signs of inflammation in the body interestingly went down. It was a very nice curve, a downward curve, and these blood markers showed that she responded very well to the therapy after just two weeks," said Azad.

Given that all standard antibiotics failed, or proved toxic, Azad said, "This is a very exciting moment for... Canadian medical research."

It's also a new form of personalized medicine.

Samples of the bacteria behind Turcotte's infection -- methicillin-resistant Staphylococcus epidermidis -- were sent to Winnipeg to find the correct phage that would target and kill them.

"It took our researchers several weeks to find a match and develop the treatment," wrote Steven Theriault, CEO of Cytophage in an email to CTV News.

Phage scientist Steffanie Strathdee, co-director of the Center for Innovative Phage Applications and Therapeutics and the associate dean of Global Health Sciences at the University of California, San Diego, says it's an important step.

"Health Canada's been criticized recently for its slow pace and approving compassionate use cases for phage therapy, and seeing Health Canada moving in this direction is terrific," said Strathdee.

Born and educated in Canada, Strathdee has become a fierce advocate for phage research detailed in her book "The Perfect Predator," which describes her journey to save her husband's life with phage therapy.

While it is early days, with Turcotte being monitored closely, Azad says she hopes to test the approach on at least four other patients, who risk losing their limbs or their lives to treatment-resistant joint infections.

Every year, about 130,000 Canadians get a new knee or hip replacement with one to two per cent developing infections.

In these cases, bacteria can stick to the foreign implant itself, creating what doctors call a "biofilm" that becomes difficult to eradicate. It can cause pain, erode bone and tissue, and often lead to revision surgeries to repair the damage around the implants. Occasionally, the entire limb requires amputation. 

"I see them every week," said Azad. "They have severe depression, suicidal thoughts, you know, patients sometimes go on to have limb amputation, it's a nightmare," she told CTV News, adding, "I think one of the benefits of studies like this is to show that there is hope."

Smart bombs

Phages exist in water, soil, and sewage, and act like viral smart bombs that attack bacteria. They target bacteria and inject their DNA to produce more phages until the microbes explode, expelling billions more phages that search for new targets.

They were co-discovered back in 1917 by French Canadian scientist Felix d'Herelle. He found they were adept at controlling outbreaks of dysentery and typhoid plague.

Phages were abandoned in favour of antibiotics, which could be mass-produced and were much more profitable.

Now, the rise of antimicrobial resistance poses a major threat to global health. Treatment-resistant bacteria was estimated to cause nearly 5 million deaths worldwide in 2019.
Phage research is moving ahead more quickly in Europe and the U.S., where researchers in Maryland reported in January of 2022, that a 64-year-old patient with chronic joint replacement infection was given phage therapy during her operation by IV, and was "able to achieve cure of her prosthetic joint infections."

Other phage treatment studies for infections after joint replacement show no severe side effects, with no signs of infection relapse after two years of follow-up.

Phage therapy, however, remains experimental and not available in Canada outside of clinical trials.

The Ottawa Hospital says it is not currently accepting patient referrals for phage therapy clinical trials, but individuals can search for clinical trials online, "and discuss any trials of interest with their health care provider."