Microbiomas Hospitalarios y resistencia Antimicrobiana: Bases Ecológicas, Mecanismos Moleculares y Estrategias de Mitigación
Resumen
La resistencia antimicrobiana en el entorno hospitalario constituye un problema de alta complejidad biológica, clínica y epidemiológica. El hospital debe entenderse como un ecosistema microbiano dinámico donde interactúan superficies ambientales, dispositivos médicos, pacientes y personal sanitario. En este contexto, la presión antibiótica, los protocolos de desinfección y la alta densidad de pacientes modulan la composición del microbioma hospitalario, reduciendo su diversidad y favoreciendo la acumulación de genes de resistencia. El resistoma hospitalario, integrado por múltiples determinantes genéticos, se consolida como un reservorio activo con capacidad de diseminación. Los mecanismos moleculares que sustentan esta dinámica incluyen la transferencia horizontal de genes mediante conjugación, transformación y transducción, así como la acción de elementos genéticos móviles como plásmidos, transposones e integrones. La formación de biopelículas en superficies y dispositivos invasivos refuerza la persistencia bacteriana y dificulta la acción de antimicrobianos y desinfectantes. Como consecuencia, patógenos multirresistentes como enterobacterias, Pseudomonas spp., Acinetobacter spp. y Staphylococcus aureus resistente a meticilina se asocian a infecciones graves, aumento de mortalidad, prolongación de la estancia hospitalaria y mayores costos sanitarios. Las herramientas de secuenciación metagenómica y vigilancia genómica han permitido caracterizar con mayor precisión el microbioma hospitalario y rastrear brotes. Sin embargo, persisten limitaciones metodológicas y la necesidad de integrar datos ecológicos y clínicos. La mitigación efectiva requiere programas de optimización de antimicrobianos, control ambiental basado en evidencia, diseño hospitalario seguro y enfoques interdisciplinarios apoyados en inteligencia artificial para anticipar riesgos y contener la diseminación de la resistencia.
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Derechos de autor 2026 Yendri Ramírez Alpízar, Raúl Zeledón Mayorga , María José Alfaro Vellanero , Karla Robleto López , Paola Sánchez Traña
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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