Current Antibiotic Resistance Profile of ESKAPE Pathogens in a Nepalese Hospital: A Cross-Sectional Study.

Abstract

Background: Antimicrobial-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) species pathogens pose a threat to global health by limiting available treatments, escalating the burden of disease, and raising mortality rates. This study investigated the prevalence of ESKAPE pathogens in different infections in a Nepalese hospital and studied their antibiotic resistance pattern. Methodology: The study was performed from September 2022 to February 2023 at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. ESKAPE pathogens were isolated in accordance with standard procedures and subjected to antimicrobial susceptibility testing (AST). Identification was done via biochemical testing. The rates of multidrug resistance (MDR), production of extended-spectrum beta-lactamase (ESBL), and methicillin resistance were studied and statistically compared in terms of the type of pathogen, infection, and hospital admission. Result: Altogether, 7429 different clinical samples were cultured and ESKAPE pathogens were isolated from 503/1564 (32.1%) positive samples. The prevalence of these pathogens was significantly higher in admitted patients (p < 0.001). Higher rates of isolation were from urine and sputum samples. Klebsiella pneumoniae was the most prevalent organism while Enterobacter was the least. A total of 52.3% and 7.4% of the isolates were MDR and ESBL producers, respectively. A significant proportion of MDR isolates were from patients admitted to the Intensive Care Unit (ICU). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 36.8%. AST revealed comparatively lower resistance of Gram-negative rods to tigecycline, polymyxin B, and colistin sulfate. Likewise, lower resistance rates to vancomycin and teicoplanin were observed in S. aureus. Conclusion: In various clinical samples, we discovered that ESKAPE pathogens were more prevalent. In order to escape the ESKAPE's torment of antibiotic resistance, our findings urge the urgent implementation of sensible antibiotic use, training healthcare professionals in antibiotic stewardship, developing effective infection control strategies, and conducting effective surveillance.