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Science  —  7 minutes

SmartBiotic is tackling the global problem of antibiotic resistance

May 2nd, 2022
Communications team
Communications team

SmartBiotic, a Montreal-based start-up and finalist in Biron’s Phase B competition is currently developing an app that can advise a doctor and predict the best personalized antibiotic treatment for a patient. It is a particularly useful innovation at a time when we are developing increasing resistance to drug treatments.

Mathieu Raad, M.D. and CEO, and Guillaume Collard, CTO

Consider this scenario: a four-year-old child undergoes minor surgery at a Quebec hospital. As can happen, the wound becomes infected, an often trivial complication that can be treated with antibiotics. But the infection is resistant, and the child has to be admitted to intensive care. Several more antibiotics later, the infectious disease specialist decides as a last resort to prescribe a powerful antibiotic that is rarely used because it can affect the kidneys or liver.

Whether we are dealing with an ear infection, a sore throat, pneumonia, diarrhea, cellulitis and skin infections, urinary tract infections or even heartburn, they all have one thing in common: they are all bacterial infections that affect both children and adults. While some bacterial infections clear up on their own, in the vast majority of cases, an antibiotic is required among the dozens available. The question is: which one?

According to Dr. Naïm Oundali, a pediatric infectious disease specialist at CHU Sainte-Justine in Montreal who is collaborating on the SmartBiotic project, the answer to this question is not that simple. “You have to choose the antibiotic that will be both effective and have the fewest side effects. Often, this choice has to be made very quickly and in an empirical manner (i.e., trial and error) before we even have information about the exact nature of the bacteria involved and its sensitivity to common antibiotics” he says.

Key criteria a physician uses to determine which drug to prescribe:

  • Clinical: Which organ is affected (e.g., lung, kidney, ear, etc.) and how severe is the infection?
  • Local epidemiological situation: What bacteria are currently active in the community and to what antibiotics are they susceptible?
  • Patient specifics: Does this person have a history of allergies to penicillin?
First-line treatments

The considerations on which a physician bases his or her decision are grouped into standardized practice guidelines that indicate the first antibiotic(s) to be used. This is called standard, or “first-line,” treatment.

When first-line treatment does not work

It happens regularly, as in the example above, that these treatments are not effective and the clinical situation worsens even though all instructions have been followed. Medical caregivers are then faced with a bacterium that has developed resistance to the first-line antibiotic. As a result, they must resort to second- or even third-line treatments and antibiotics.

Consequences of second- or third-line antibiotics:

  1. Bacteria at the site of infection may develop resistance to these antibiotics as well and proliferate. It may even be possible for the bacteria to become resistant to all known antibiotics!1
  2. Risk of increased side effects and costs, combined with more complex treatment methods such as intravenous treatments, which require more medical staff.
Antibiotic resistance: A global problem

Although partly natural, antibiotic resistance is accelerated by excessive and inappropriate use of antibiotics (e.g., antibiotics used in the wrong context, antibiotic treatment interrupted before the prescribed period, use of antibiotics in the food industry, etc.).

The development of resistance to antibiotics is proportional to their degree of use. The more an antibiotic is used, the more likely it is that resistant bacteria will proliferate.

In 2019, antibiotic resistance was believed to be directly responsible for 1.27 million deaths worldwide.[2] Some projections suggest that the problem will get worse. It is estimated that by 2050, as many as 10 million deaths per year will be due to antibiotic resistance.[3] According to the World Health Organization, antibiotic resistance is one of the most serious threats to global health, food security and development today.[4]

The key to success: Improving information flow

With intercontinental travel and population shifts, the epidemiological situation in every country in the world is changing much more rapidly than it did 50 years ago. Therefore, first-line treatment guidelines must be constantly updated so that the physician can make an informed decision based on a situation as it arises and precisely where it arises.

Even with practice guidelines, the treatment of infections is often trial and error. Often, a diagnosis is made even before a bacterium is identified: culture and antimicrobial susceptibility test results often take 24 to 48 hours to arrive.

Main sources of information that a physician uses to make a diagnosis:

  • Clinical examination: symptoms versus potential diagnoses
  • Public institutions such as the LSPQ (Laboratoire de santé publique du Québec): Its mission is to compile all cases of resistant bacteria in Quebec and regularly notify hospitals so that they can adjust their detection techniques and therapeutic guidelines.

It goes without saying that the transmission of information from public institutions is not instantaneous. It is by definition not personalized and presented in a format that does not facilitate its immediate use at a patient’s bedside.

A report published by the Institut national de santé publique du Québec (INSPQ) in September 2022 reveals that official recommendations are followed in less than 20% of cases for urinary tract infections.[5] In 2018, more than 5,000 deaths in Canada were directly attributable to antibiotic resistance, resulting in $1.4 billion in additional costs to the health care system.[6]

An innovative idea by a start-up

A small France-Quebec start-up is developing a tool that could help doctors choose the best antibiotic by providing them with all the information that applies to a situation in real time.

Dr. Mathieu Raad, founder of SmartBiotic, came up with the idea to develop this approach during numerous internships at hospitals in Madagascar and Martinique where, despite the presence of completely different bacteria, the first-line treatments were the same as those used in Paris![7]

The basic idea is simple: using artificial intelligence to evaluate the probability of a response to a range of antibiotics in a given situation based on information that is available but not very user-friendly at the time. And all this, ideally, in a simple and instantaneous manner with one tap on a smartphone. Dr. Oundali is currently developing research projects in collaboration with SmartBiotic to validate the usefulness of the app on a daily basis in Quebec.

SmartBiotic was one of the finalists of the second edition of Phase B, an initiative of Biron Health Group to showcase the full potential of health care innovators.

  1. “La guerre aux superbactéries.” La Presse, February 6, 2022.
  2. “Global burden of bacterial antibacterial resistance in 2019: a systematic analysis.” The Lancet, February 2022.
  3. “Tackling drug-resistant infections globally: final report and recommendations.” Review on Antimicrobial Resistance, 2016.
  4. “Antibiotic resistance.” World Health Organization, July 31, 2020.
  5. Fortin, Élise, Caroline Quach-Thanh, Marc Dionne, Alejandra Irace-Cima, Caroline Sirois, Marc Simard, Sonia Jean and Nadine Magali Ufitinema. “Impact des maladies chroniques sur la prescription des antibiotiques selon les guides cliniques dans la communauté,” Institut national de santé publique du Québec, 26 p., September 7, 2022.
  6. Fortin, Élise, Caroline Quach-Thanh, Marc Dionne, Alejandra Irace-Cima, Caroline Sirois, Marc Simard, Sonia Jean et Nadine Magali Ufitinema. “Impact des maladies chroniques sur les taux d’utilisation des antibiotiques dans la communauté,” Institut national de santé publique du Québec, Surveillance des maladies chroniques, no. 38, 26 p., March 30, 2022.
  7. “Avec SmartBiotic, nous voulons lutter contre l’antibiorésistance, mieux prescrire et sauver des vies.” What’s Up Doc?, April 19, 2022 (updated July 25, 2022).
Communications team
Communications team