November 28, 2022

For this month’s Member Spotlight, we spoke with Susy Hota, medical director of Infection Prevention and Control and an infectious disease specialist at the University Health Network. She is also an associate professor in the department of medicine at the Temerty Faculty of Medicine at the University of Toronto and co-lead of the University of Toronto Microbiota Therapeutics Outcomes Program.

Can you describe your research?

I co-lead a program called the University of Toronto Microbiota Therapeutics Outcomes Program (MTOP), which is a clinical and research program where we have developed a platform for manufacturing and providing fecal microbiota transplantation (FMT) to patients with recurrent Clostridium difficile infection. We also support a number of clinical trials that are looking at possible applications of FMT for other health conditions. We have collaborators who have evaluated the effects of FMT on morbid obesity and metabolic parameters. There’s another MTOP study looking at the applications of FMT in treating bipolar disorder. This area of research is burgeoning and many U of T researchers are active in microbiome research so the future potentials of MTOP are limitless.

How did you become interested in infectious diseases?

My older sister studied microbiology and immunology in university and she would come home with all kinds of bizarre tales and facts about microorganisms, which I found fascinating. I think that’s probably where my interest began when I was younger. I also went on to study microbiology and immunology in my undergraduate and it amazed me how microbes always appeared to be one step ahead of us. We have so much to learn from them! When I went through medical school, I did contemplate other specialties but in the end, the subspecialty in internal medicine that satisfied me the most was infectious diseases. The breadth of it is incredible. You could concentrate on infectious diseases endemic to distant countries, like in tropical medicine, or you could focus right down to the minutiae of researching the mechanism of infection of a specific pathogen in the lab. Then there’s everything in between.

What are some challenges you face in your work?

With MTOP, the donor side of the program has been an interesting learning experience and also incredibly challenging. In early days, there was little guidance on how to conduct FMT donor screening and design effective donor programs. It took a lot of effort to develop and refine our standard operating procedures for a high-quality donor program. Then, in 2020, we had to pause the program because of the pandemic, which made it very difficult to recruit and retain donors. We didn’t want stool donors coming into the hospital environment, even if it was to just drop off samples, and we needed to figure out how to deal with this new emerging pathogen. We knew that SARS-CoV-2 could be detected in stool but we needed to understand the clinical implications to FMT programs and donor screening specifically. Last year, monkeypox emerged in Canada. So we’ve had to constantly revisit and modify our protocols for donor screening based on these emerging infectious diseases.

Those are some challenges we’ve faced in MTOP. The majority of my professional time is actually spent leading UHN’s Infection Prevention and Control (IPAC) Department. I could fill a book with all the challenges we have faced during the pandemic, and prior to it! But the complexity of hospital IPAC, and preparedness for infectious diseases emergencies, which has always been an academic focus of mine, is what attracts me to it.

World Antimicrobial Awareness Week just passed. What do you see as the biggest challenges in tackling antimicrobial resistance (AMR)?

We have much work to do. On the clinical side, we must improve training of healthcare providers to be aware of the possible harms of antimicrobials and act as good stewards of antimicrobials. That seems to have fallen by the wayside through the pandemic. With all resources and attention diverted to COVID-19, awareness and monitoring for healthcare-associated infections and antimicrobial resistance organisms has decreased. And with what feels like one crisis after another, it’s hard to redirect people’s attention to something that’s been grumbling in the background for a long time and continues to escalate. Sadly, AMR is likely to join the ranks of crisis during our lifetime, which is frightening. I especially worry about drug-resistant organisms like Candida auris, which has been causing outbreaks in different parts of the world and will likely be increase in Canada, with travel picking up at this stage in the pandemic.

What excites you the most about EPIC?

It’s a very exciting time for EPIC to launch and in many ways, it’s been long overdue. Up until this point, many incredible researchers, clinicians and policymakers have been working in the realm of emerging infectious diseases and yet, we haven’t always collaborated together in an effective way because we haven’t had a structure to do that. There’s so much power in what we can do at U of T with the right supports in place, and with the tools to connect people and their research. It’s going to lead us to a better place so that the next time we’re dealing with a pandemic or an emerging pathogen, research and evidence-informed response can happen quicker.

What are you reading right now?

I like to read books that are set in different times or that take you to a different place from where you’re living. Lately I’ve been reading Labyrinth by Kate Mosse. It’s mostly set in southwestern France in medieval times and it goes back and forth between then and 2005. The story follows characters that have parallel lives and are connected in some way. It’s light, fun reading but I think sometimes you just need that.