Posted by: calloftheandes | April 12, 2016

Invisible World of Bacteria Featured by Ecuadorian Researcher

IMG_0448 (2)Germs with elaborate names such as Escherichia coli (E. coli) and Staphylococcus aureus are featured prominently in a new book detailing the findings of 15 years of research done at a mission hospital in Ecuador.

The 246-page book, 15 Años Vigilando Lo Invisible (15 Years of Watching the Invisible), is an academic work that responds to concerns expressed by healthcare and research experts who met in Venezuela for a Pan-American Conference on Antimicrobial Resistance.

A tour de force of documented and chronicled germs, the book debuted in late 2015 when its author, Dr. Jeannete Zurita, addressed those gathered for a formal observation of the 60th anniversary of Hospital Vozandes-Quito (HVQ) where the research took place. Zurita’s work at the Reach Beyond facility, based in Ecuador’s capital city, spans more than two decades.

Dr. Jeannete Zurita

Dr. Jeannete Zurita

“We were professionals from the disciplines of microbiology, infectology and public health as well as others,” Zurita wrote of the meeting in Caraballeda, Venezuela, in the late 1990s. The conferees debated factors contributing to increasingly resistant germs—germs not only resistant to medicines but also to other attempts at control.

The experts’ discussion pointed to suspected influences that were creating superbugs such as incorrect use of pharmaceuticals and inadequate germ monitoring efforts. Then anticipating ways to help future researchers and other professionals make informed decisions, they determined that “all the countries of the Americas, including Ecuador, committed to begin surveillance on [germ] resistance.”

The conference in Venezuela took place in late 1998. By 1999 HVQ had begun monitoring bacterial resistance in 22 Ecuadorian hospitals through the Red Nacional de Vigilancia de Resistencia Bacteriana (National Network of Surveillance of Resistant Bacteria). At the mission hospital, installation of World Health Organization software called WHONET facilitated compilation and analysis of data on microbials. In 2010 the surveillance was transferred to the Instituto Nacional de Investigación en Salud Pública (INSPI).

Much later, the Red Nacional de Vigilancia de Antimicrobianos del Ecuador (Ecuador National Network of Antimicrobial Surveillance) was established in 2014. In addition to her work at HVQ and her privately operated laboratory, Zurita was named the network’s director.

Infection and colonization by E. coli in the Quito hospital accounted for 46 percent of all bacteria isolated during the 15-year study on over 20,000 lab samples. This put E. coli as the leading bacteria documented at the Quito facility and it has been confirmed elsewhere as causing outbreaks of illness and sometimes deaths. In the U.S., for example, health authorities linked one such outbreak to contaminated ingredients at a restaurant chain and another outbreak to food sold at a department store franchise.

The data revealed 4,680 isolates of Staphylococcus aureus (more than one each day of the study period). Placing a distant second place after E. coli, this is the bacterium commonly known as staph. Staph infections may range from a simple boil to a far more serious episode with flesh-eating infection. Another type of staph infection—called cellulitis—involves the skin.

Dr. Zurita (in striped blouse) awaits her turn at the podium during an HVQ anniversary celebration.

Dr. Zurita (in striped blouse) awaits her turn at the podium during an HVQ anniversary celebration.

Coincidentally, this was the malady affecting one of Zurita’s fellow speakers at the HVQ anniversary event, Reach Beyond’s Dr. Roy Ringenberg, during his visit to Ecuador. In his speech, he praised his caregivers, some of the same colleagues with whom he had worked while serving as a missionary doctor in Ecuador.

Zurita, speaking about the book at the Oct. 15 anniversary celebration in Quito, presented her findings and later offered people signed copies of 15 Años Vigilando Lo Invisible. The 60th anniversary event came 16 months after the hospital’s sale was announced to employees and the public—a deal that later fell through.

In the book, Zurita reviewed literature of increasingly resistant bacteria and acknowledged research concurrent with the HVQ data collation. She mentioned her basic belief about resistance was “‘no man, no resistance,’ but it seems that the resistance of bacteria is more surprising than we had believed.”

On the Galapagos Islands, for example, where Ecuador has set emigration quotas, antibiotic use falls behind areas of denser populations. However, scientist Maria Cristina Thaller has found resistant bacteria among iguanas, according to Zurita. (The study did not directly interface with Zurita’s but is part of the literature.)

Research by María Dominguez-Bello in 2009 found antibiotic-resistant bacteria among the Yanomami people. Their hunter-gatherer existence in remote Venezuela affords them little contact with modern medicine or a Western diet.

Zurita cited additional discoveries, including ancient bacteria found in the permafrost of northern Canada’s Beringia region in the Yukon. Another example from the Lechuguilla Cave of New Mexico demonstrated resistant bacteria even though their habitat had never been exposed to antibiotics.

Such situations pose conundrums to researchers and beg such questions as, “Is it possible to stop resistant bacteria?” Devoting one full chapter to that exact query, Zurita notes that “MRSA is endemic in many hospitals,” especially those high in specialties and in patient numbers.

MRSA—Methicillin-resistant Staphylococcus aureus—“is growing worldwide and Latin America is no exception,” she wrote. As clones of these bacteria begin to circulate, they exacerbate the situation.

With another dozen Ecuadorian hospitals now reporting bacteria data along with HVQ, Zurita briefly touched upon bed count and specialty numbers, and also drew attention to hygiene practices. “The only way to change this panorama is with three indispensable requirements,” she wrote. “[These are] clean hands, clean patients and a clean hospital.”

In the book’s acknowledgments, Zurita thanks HVQ Director Dr. Ximena Pacheco. She credits the title, 15 Años Vigilando Lo Invisible, as a suggestion offered by the hospital’s medical education director, Dr. José Luis Recalde.zurita1

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Responses

  1. […] Dr. Jeannete Zurita’s book, 15 Años Vigilando Lo Invisible, is quietly contributing to the body of medical research literature done by Christian mission agencies, including Reach Beyond. […]


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