Pathogen Dynamics Across Clinical Syndromes: A Four-Year Institutional Surveillance of Healthcare-Associated Infections in Ecuador

Introduction: Local institutional microbiological profiles are relevant for empirical therapy, infection-prevention planning, and antimicrobial stewardship, particularly in resource-limited settings where standardized surveillance data remain limited. Materials and Methods: A retrospective descriptive surveillance analysis was conducted using aggregated microbiological data from institutional healthcare-associated infection (HAI) surveillance between January 2022 and July 2025 in a secondary-level hospital in Ecuador. Reported HAIs were categorized as ventilator-associated pneumonia (VAP), bloodstream infection (BSI), urinary tract infection (UTI), and surgical site infection (SSI). Prioritized pathogens included Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans. Absolute frequencies and relative proportions were analyzed descriptively. Results: A total of 1,013 reported HAIs were identified. VAP was the most frequent syndrome (331 cases; 32.7%), followed by BSI (219; 21.6%), UTI (64; 6.3%), and SSI (24; 2.4%). Among prioritized pathogens, Acinetobacter baumannii was the most frequently reported microorganism (127 isolates; 12.5% of total HAIs). Pseudomonas aeruginosa was recorded from 2023 onward and showed the highest number of reports in 2024, while Klebsiella pneumoniae was more frequently reported during 2024 and January-July 2025. Escherichia coli remained mainly associated with urinary isolates. Staphylococcus aureus was infrequent overall but was more frequently reported during January-July 2025. Candida albicans was recorded only in 2022 within the prioritized surveillance dataset. Conclusion: Reported HAIs in this institution were predominantly represented by VAP and BSI, with a prioritized microbiological profile dominated by non-fermenting Gram-negative bacilli, particularly A. baumannii. These findings should be interpreted as descriptive institutional surveillance signals rather than definitive incidence trends, because standardized denominators, patient-level variables, antimicrobial susceptibility trends, and isolate deduplication were unavailable. The results support strengthening standardized microbiological surveillance, device-associated infection monitoring, and future integration of antimicrobial resistance data.