César Marcelo Larrea-Álvarez

Background/Objectives: The gut microbiota is fundamental to human health. Probiotics are key interventions for modulating microbial balance, requiring future healthcare professionals to understand these concepts. Evidence evaluating the knowledge, attitudes, and practices (KAP) of medical students in Ecuador is limited. This study assessed these aspects among students in Greater Guayaquil. Methods: A cross-sectional study was conducted at a university in Samborondón between August and November 2025. A previously published questionnaire was used to collect data on microbiota and probiotic knowledge, attitudes, and personal practices. Data were analyzed using descriptive statistics and multivariable regression. Results: Among 382 participants, the mean knowledge score was 22.76 ± 9.1 out of 44 (52.7%). Higher scores were associated with advanced academic standing and prior formal instruction. Significant gaps were observed in probiotic safety and microbiota–drug interactions. Attitudes were positive (median 10/16), with strong support for enhanced training. Probiotic use was common, though uncertainty about product composition and administration persisted. Conclusions: Medical students possess moderate yet uneven knowledge of microbiota and probiotics, alongside positive attitudes. These findings suggest the need for greater emphasis on microbiota science, probiotic safety, and drug interactions within medical curricula.

Background: Enterobacter hormaechei, a member of the Enterobacter cloacae complex (ECC), is increasingly recognized as a multidrug-resistant (MDR) nosocomial pathogen. However, subspecies-level genomic data from Ecuador remain limited. Methods: Four clinical E. hormaechei isolates from a hospital in northern Ecuador were analyzed using antimicrobial susceptibility testing and whole-genome sequencing (WGS). Genomic characterization included multilocus sequence typing (MLST), resistome profiling, plasmid replicon detection, integron screening, genomic island analysis, and phylogenetic comparison with publicly available Ecuadorian genomes. Results: WGS identified three isolates as subsp. xiangfangensis (ST136 and ST337) and one as subsp. hoffmannii (ST145). Two ST136 isolates exhibited extensive MDR phenotypes associated with bla_CTX-M-15, bla_OXA-1, bla_ACT-16, and additional aminoglycoside and fluoroquinolone resistance genes. ST145 showed moderate resistance, whereas ST337 remained largely susceptible despite harboring bla_ACT-16. Multiple genomic islands and plasmid replicons (IncF/IncR or IncHI2) were detected. Phylogenetic analysis demonstrated clustering with previously reported Ecuadorian lineages. Conclusions: This study provides subspecies-level genomic characterization of clinical E. hormaechei in Ecuador and describes heterogeneous resistance profiles and associated mobile genetic elements, contributing baseline data for regional surveillance.