Reporte de Caso

El hospital como ecosistema: reservorios ambientales emergentes de bacterias multirresistentes y sus implicaciones para el control de infecciones

Volumen XXX, Edición 3, Setiembre - Diciembre 2026

Publicación: 30-09-26

DOI: https://doi.org/10.55139/ABVO1271

Daniel Cascante Serrano
División de Microbiología, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Alexandra Carrillo Pérez
Unidad de Control y Prevención de Infecciones, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Bárbara de la Cuesta Barboza
Unidad de Control y Prevención de Infecciones, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Kattia Amador Ramírez
Unidad de Control y Prevención de Infecciones, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Juan Carlos Gómez Rojas
Unidad de Control y Prevención de Infecciones, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Manuel Ramirez Cardoce
Unidad de Control y Prevención de Infecciones, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

Elvira Segura Retana
División de Microbiología, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José, Costa Rica.

José Arturo Molina Mora
Centro de Investigación en Enfermedades Tropicales (CIET), Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.

Kenia Barrantes Jimenez
Instituto de Investigaciones en Salud (INISA), Universidad de Costa Rica, San José, Costa Rica.

Luz Chacón Jiménez
Instituto de Investigaciones en Salud (INISA), Universidad de Costa Rica, San José, Costa Rica.

Resumen

Las infecciones asociadas a la atención en salud (IAAS) representan un desafío creciente a nivel global, particularmente por su asociación con microorganismos multirresistentes (MDRO), lo que complica el manejo clínico y aumenta la morbimortalidad. Aunque las estrategias tradicionales de prevención y control han demostrado efectividad parcial, su impacto se ve limitado por la persistencia de reservorios ambientales hospitalarios, especialmente en sistemas hídricos y superficies de alto contacto. El objetivo de esta revisión es sintetizar y analizar críticamente evidencia sobre el papel de tuberías y superficies hospitalarias como reservorios persistentes de MDRO, su contribución a la transmisión nosocomial y las implicaciones para el diseño de intervenciones de control más efectivas. Se integró literatura científica reciente con enfoques aplicados al control de IAAS, considerando identificación de reservorios, principales patógenos bacterianos y genes de resistencia a los antibióticos, así como métodos de estudio disponibles. La evidencia muestra que estos reservorios actúan como nichos ecológicos que favorecen la formación de biopelículas, la persistencia microbiana y el intercambio de genes de resistencia, facilitando la diseminación de patógenos entre el ambiente y los pacientes. Los estudios genómicos han permitido establecer vínculos entre aislamientos ambientales y clínicos, apoyando su papel en la transmisión hospitalaria. En consecuencia, el control de las IAAS requiere estrategias integradas que incluyan rediseño de la infraestructura, protocolos de limpieza dirigidos y vigilancia microbiológica combinada. El reconocimiento del entorno hospitalario como un componente activo en la epidemiología de la resistencia antimicrobiana es clave para el desarrollo de intervenciones más efectivas y sostenibles.

Palabras claves

Infección Cruzada; Farmacorresistencia Microbiana; Monitoreo Ambiental; Tuberías; Biopelículas.

Abstract

Healthcare-associated infections (HAIs) represent a growing global challenge, particularly due to their association with multidrug-resistant organisms (MDRO), which complicate clinical management and increase morbidity and mortality. Although conventional prevention and control strategies have shown partial effectiveness, their impact is often limited by the persistence of environmental reservoirs within hospital settings, especially in water systems and high-touch surfaces. This review aims to synthesize and critically analyze the emerging evidence on the role of hospital plumbing and surfaces as persistent reservoirs of MDRO, their contribution to nosocomial transmission, and the implications for the design of more effective control interventions. Recent scientific literature was integrated with applied approaches to HAI control, addressing the identification of environmental reservoirs, key pathogens and resistance genes, and the methodologies used for their study. Evidence indicates that these reservoirs function as ecological niches that promote biofilm formation, microbial persistence, and horizontal gene transfer, facilitating the dissemination of pathogens between the environment and patients. Genomic studies have demonstrated links between environmental and clinical isolates, supporting their role in hospital transmission dynamics. Consequently, effective HAI control requires integrated strategies that include infrastructure redesign, targeted cleaning protocols, and combined microbiological surveillance. Recognizing the hospital environment as an active component in the epidemiology of antimicrobial resistance is essential for developing more effective and sustainable interventions.

Keywords

Cross Infection; Drug Resistance, Microbial; Environmental Monitoring; Pipelines; Biofilms.

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