ESKAPE Pathogens in Bloodstream Infections: Dynamics of Antimicrobial Resistance from 2018 to 2024-A Single-Center...

Background/Objectives: Modern healthcare faces a growing burden of antimicrobial resistance, prominently driven by ESKAPE pathogens. These organisms-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.-are the leading causes of healthcare-associated infections, associated with limited therapeutic options and increased morbidity. Continuous surveillance is crucial for informing empirical therapy and guiding stewardship. Methods: We perform a single-center, seven-year retrospective study (2018-2024) at a 1000-bed tertiary hospital in Warsaw, Poland. Bloodstream isolates of ESKAPE pathogens were identified according to the EUCAST guidelines. Data were analyzed by pathogen, ward, and year of isolation. Results: From 2483 positive blood cultures, 3724 ESKAPE pathogens were recovered. S. aureus and K. pneumoniae predominated, particularly in the Intensive Care Unit and Hematology ward. Resistance analysis revealed persistently high vancomycin resistance in E. faecium, variable but notable methicillin resistance in S. aureus, and frequent ESBL production in K. pneumoniae with an alarming rise in carbapenemase-producing strains, including dual NDM + OXA-48 co-producers. A. baumannii exhibited near-universal multidrug resistance. P. aeruginosa demonstrated lower resistance rates with preserved colistin susceptibility, while Enterobacter spp. remained fully carbapenem-susceptible. Linezolid retained activity against E. faecium, while colistin remained effective against A. baumannii and P. aeruginosa. Modern β-lactam/β-lactamase inhibitor combinations were active against K. pneumoniae. Conclusions: Our findings underscore the critical role of ESKAPE pathogens in bloodstream infections and highlight divergent resistance patterns across species. The emergence of carbapenemase-producing K. pneumoniae and the persistence of multidrug-resistant A. baumannii are of particular concern. Sustained surveillance, robust antimicrobial stewardship, and tailored infection control strategies remained essential to curb the evolving resistance threat in tertiary care settings.