Prevalence and antimicrobial resistance trends of ESKAPEE pathogens in clinical isolates from Hyderabad, Pakistan: a...

Antimicrobial resistance is a major global health threat that limits treatment options and increases morbidity and mortality. ESKAPEE pathogens are prioritized by the World Health Organization and the Centers for Disease Control and Prevention because of their role in nosocomial infections and their ability to evade antimicrobials. This study aimed to determine the prevalence and antimicrobial resistance patterns of ESKAPEE pathogens in Hyderabad, Pakistan.

A cross-sectional study was conducted from August 2023 to August 2024 at the University of Sindh. A total of 1072 clinical specimens were processed for bacterial isolation, identification, and antimicrobial susceptibility testing following Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. Isolates were classified as multidrug-resistant, extensively drug-resistant, or possible pandrug-resistant using the Magiorakos et al. criteria and the Centers for Disease Control and Prevention/Infectious Diseases Society of America definitions.

Among positive cultures, ESKAPEE pathogens accounted for 82.1% of isolates. Escherichia coli was the most prevalent (49.8%), followed by Klebsiella pneumoniae (13.2%), Acinetobacter baumannii (9.7%), Pseudomonas aeruginosa (9.3%), Enterococcus spp. (8.3%), Staphylococcus aureus (8.0%), and Enterobacter spp. (1.7%). High resistance was observed to β-lactams, cephalosporins, and fluoroquinolones. Carbapenem resistance ranged from 11.1% to 25.7% in E. coli, 29.0% to 39.5% in K. pneumoniae, 48.2% in P. aeruginosa, and 60.7% to 64.3% in A. baumannii.

The high burden of multidrug-resistant and extensively drug-resistant ESKAPEE pathogens highlights the urgent need for strengthened antimicrobial stewardship, continuous surveillance, and rigorous infection-control strategies.