While the problem of AMR has reached a tipping point in India, there are countless and yet, often unheard of superheroes – in research labs, hospitals, and on the ground, among communities – who are working very hard to stop the rise of these deadly superbugs. In our SaS-AMR Champions Series, commemorating the World Antimicrobial Awareness Week (WAAW2021), we bring to you conversations with some of these ‘Superheroes Against Superbugs’ that we hope would inform, inspire, and encourage us all to act against AMR to ensure a healthy future for all.
Suman Kapur and her team based at BITS Pilani, Hyderabad, have developed a unique device called RightBiotic that rapidly identifies antibiotic sensitivity of pathogens found in human Urinary Tract Infections (UTI) and helps a medical professional identify the right kind of antibiotics to prescribe to treat the infection. Rapid and accurate diagnosis of infections will enable more appropriate antibiotic prescription practices, thereby, reducing inappropriate use of antimicrobials. For her efforts, Suman has received the All-India Women Entrepreneur Award 2021 in the category of Super Achiever by the Delhi Management Association. She was also recognized as one of 100 Women Achievers by the President of India in 2015. The RightBiotic team was awarded the Gandhian Young Technological Innovation Award in 2015. In this interview, Suman takes us through the science behind RightBiotic and why it is an effective biomedical tool to control the rise of superbugs.
How did you become interested in working on diagnostics for drug-resistant infections?
Suman: When I was based at BITS Pilani, Rajasthan, I would often see villagers not getting tested when they had an infectious disease. This was also largely because the villages did not have the facilities for it. Patients were prescribed antibiotics without any knowledge of what would work for their infection. In 2007, India’s Defence Research and Development Organisation (DRDO) put out a call to develop a product of biotechnological utility. At the same time, AMR was just getting highlighted by the World Health Organisation (WHO) and various media agencies. Given the prevalence of UTIs in the country, we proposed to develop a portable, point-of-care device for testing for bacterial pathogens in urine. Since these infections also contribute to a great deal of antibiotic usage, we added the possibility of estimating AMR in urological bacteria in the same project.
Your device, RightBiotic tests bacteria causing Urinary Tract Infection for their sensitivity towards antibiotics. How does it work? Can it be used for conditions other than Urinary Tract Infections?
Suman: RightBiotic works on the tenets of classical microbiology and inhibition of growth of pathogenic bacteria in the presence of antibiotics. The RightBiotic kit includes strips of culture wells, reagents and media. There are two different kinds of strips, 1) to identify the pathogenic bacteria and determine its quantity (or bacterial load), and 2) to identify the antibiotics that would work against these bacteria. Doctors culture bacteria from patient samples in the culture well strips. On one strip, seven different antibiotics can be tested together for their effect on bacteria in the sample. If the antibiotics kill the bacteria, there is a colour change in 4 hours. Our technology comprises a colour change detecting machine and a reagent kit. It can read the colours on the strips, and quickly identify the correct antibiotics for each patient.
“By using the RightBiotic system, not only can one identify the bacterial infection but also the antibiotics required in each case. We made a case for personalized antibiotic choice for each patient.”
Though we had started off developing the test for urine samples, we have now gone beyond it. The test can be now used with pus, swabs, wound discharge, ascitic fluid, cerebrospinal fluid (CSF) and blood samples. This helps in testing for sepsis, bacterial meningitis, abdominal infections and non-healing wound discharges.
What have been some of the challenges in getting the new technology more widely accepted and why do you think that is?
Suman: Microbiologists traditionally believe more in observations made by their eyes through a microscope than a machine. This has been the biggest hurdle in getting the new technology accepted. There is also a huge preference for testing Minimum Inhibitory Concentrations (MIC) for antibiotics among medical professionals. And this has been a drawback for us as it increases the cost of our rapid test. MIC is the minimum amount of antibiotics required for inhibiting the growth of pathogenic bacteria. On the other hand, RightBiotic is a good choice for identifying the infection-causing bacteria, and its broad sensitivity towards a single concentration of a particular antibiotic as per Clinical & Laboratory Standards Institute (CLSI) guidelines. While MIC is important for serious life-threatening infectious diseases with high mortality incidence, carrying it out for standard Out Patient Department (OPD) cases adds to costs manifold. However, in regular OPD scenarios, patients are given standard doses of antibiotics and, therefore, RightBiotic is well-suited in such cases.
“Microbiologists traditionally believe their eyes and microscopic observations more than a machine. This has been the biggest hurdle in getting the new technology accepted.”
Your technology has also been used to identify antibiotic residues in the environment, particularly in the water bodies of Hyderabad. Can you tell us more about your finding there? Also, how else can this technology be used?
Suman: Last year, during COVID-19, we used our technology to identify superbugs in the water bodies of Hyderabad along the 200 km stretch of Musi River. We tested 98 cultures of microbes (or isolates) from 54 samples from this surface water body. To our utmost surprise, we found each of them was resistant to more than one antibiotic and several of them were resistant to more than three antibiotics (MDR-multidrug resistance) or more than five antibiotics (XDR-extensive drug resistance). This study was done in collaboration with the Centre for Pollution Control Board, Delhi and Telangana State Control Board, Hyderabad. Such surveillance is under consideration at all state control board labs.
Since this technology allows for doing biochemical reactions that have colour endpoints, it can also be used to estimate the presence of adulterants in milk.
What would be your call to action to the general public to help tackle AMR?
Suman: AMR can only be tackled by an intersectoral approach in which
a) antibiotics should be prescribed only when the antibiogram (profile of antibiotic susceptibility of a disease-causing pathogen) is available;
b) antibiotics should not be sold over the counter without a doctor’s prescription;
c) doctors should be extra careful in prescribing broad-spectrum antibiotics;
d) consumers should be made more aware that every infection in the body does not need antibiotics for cure. Infectious agents such as viruses, fungi and parasites are not killed by antibiotics; and
e) antibiotics reserved for use in humans should not be used in the dairy and poultry industry and agriculture.
Interview by Team SaS and Moneca Kaul; Moneca is a PhD researcher based at CCMB, Hyderabad. She is studying the bacterial cell wall and proteins that break this wall to accommodate new cell wall material as the bacterial cells grow and divides.
Cover Art by Rupsi Khurana
Learn more about AMR and what you can do to stop the rise of superbugs here.