The Q&A: Luis Ostrosky-Zeichner

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week’s subject:

Dr. Luis Ostrosky-Zeichner is director of the Laboratory of Mycology Research, professor of infectious diseases and vice chair of medicine at McGovern Medical School at UTHealth. He recently worked with the Centers for Disease Control and Prevention to develop guidelines on a new superbug threat. 

Editor's note: This interview has been edited for length and clarity. 

Trib+Health: Can you expand on the recent superbug threat, and why the Centers for Disease Control and Prevention is worried about it?

Luis Ostrosky-Zeichner: Candida is part of what humans normally carry in our body. We all carry it in our gastrointestinal tract, in our skin and in our genital tract as well.

For the most part, whenever someone has had an issue with Candida, it's been women with Candida Vaginitis or babies with thrush — that's what most people know about this organism.

But in hospitalized patients, when you are undergoing a lot of medical procedures, it can actually cause a bloodstream infection. It can be very severe and life threatening. 

So over the past couple of decades, we've developed new antifungals and new ways to diagnose this infection, and we pretty much have had a good handle on it. The worst thing about this particular Candida strain is that it appeared in 2009 and it's not something we've seen before in humans.

Most recently, it has caused large outbreaks in critical care units. We're not used to seeing outbreaks of this particular strain in hospitals. Not only does it cause outbreaks, but it has a higher mortality than we've seen with the normal Candida strains. It's also resistant to multiple antifungals we have used for this infection. 

The concern is that it's behaving in a way where we don't usually see Candida behave. This strain is causing outbreaks, has resistance to many antifungals and has a higher mortality than what we're used to seeing. 

Trib+Health: What's been your role in working with the CDC to develop guidelines, and what were some of your largest challenges? 

Ostrosky-Zeichner: My area of research is in Candida, and I've worked in developing a lot of antifungals that we have now for the infection. I've also studied the epidemiology of this infection, coming up with rules to predict who's going to get it while in the hospital.

I've also worked with ways to test Candida against antifungals to see if they're going to work or not. I'm pictured as an expert in the field, and as such, I've contributed to the national guidelines by the Infectious Diseases Society of America on the diagnosis and management of these infections in general.

Now that we're having issues with this particular species, the CDC asked me to help with guidelines for diagnosis, treatment and infection prevention. The challenge we've had is that we're just starting to learn the epidemiology and behavior of this particular strain, so there's not a lot of information as to how to treat or prevent it.

We're having to extrapolate from general principles we have from other Candida species and other general infection principles as well. 

Trib+Health: Where do you see the threat of this superbug heading?

Ostrosky-Zeichner: I think we're going to see more clusters of this infection pop up throughout the U.S. and other countries around the world. We're also going to start collecting more data on patients and cases, and maybe we'll come up with more firm guidelines based on what our experiences are with the cases we have so far. 

Trib+Health: What advice can you give people? 

Ostrosky-Zeichner: This is a hospital-associated infection, so it's very important while you're in the hospital to be your own advocate and ask your healthcare staff to wash their hands when they come in to see you. We always tell our patients that it's okay to ask what's happening. 

Trib+Health: Is there anything you'd like to add to today's conversation? 

Ostrosky-Zeichner: This is just one of the latest organisms we're facing, and it really showcases how we're lagging behind in antibiotics and antifungals.

This is a very important area of research and policy where we need to be developing more antimicrobials to be responding to this type of threat.