Background
“ESKAPE” is an acronym for a group of life-threatening nosocomial pathogens, viz,
Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa
and
Enterobacter
spp. Global efforts on controlling multidrug-resistant (MDR) organisms have been hampered by their ability to escape antibacterial drugs. This study was undertaken to determine the prevalence of ESKAPE pathogens with prime focus on biofilm production and antibiotic resistance.
Methods
A total of 8756 clinical samples were processed for the isolation and identification of ESKAPE pathogens following standard microbiological procedures. These isolates were subjected to antimicrobial sensitivity test as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Test for MDR, extended-spectrum β-lactamase (ESBL), metallo-β-lactamase (MBL), methicillin-resistant
Staphylococcus aureus
(MRSA), vancomycin-resistant
Enterococcus
(VRE) was done by the disk diffusion and E-test methods. In the case of VRE molecular detection was done for
vanA
and
vanB
genes. All the isolates were processed for biofilm detection by the tube adherence method.
Results
The percentage distribution of
Enterococcus faecium
was 5.5%,
S. aureus
33.4%,
K. pneumoniae
33.0%,
A. baumannii
8.6%,
P. aeruginosa
18.6%, and
Enterobacter aerogenes
0.9%. MRSA was 57.6%, and vancomycin resistance among
Enterococcus faecium
was 20%. ESBL- and MBL-producing
K. pneumoniae
were 16.1%, and 8.1%,
A. baumannii
10.3% each and
P. aeruginosa
10.7% and 8.3%, respectively. A total of 42.3% of isolates were biofilm producers. Linezolid was the drug of choice for VRE. Ampicillin-sulbactam was most useful against
A. baumannii
apart from polymyxins, whereas piperacillin-tazobactam was effective against other Gram-negative bacteria.
VanA
gene was detected in all the VRE isolates.
Conclusion
This study estimates the burden of the ESKAPE organisms and their antimicrobial resistance pattern in a hospital setting. A high percentage of drug resistance and biofilm production was noted; hence antimicrobial resistance surveillance targeting ESKAPE pathogens should be incorporated in the infection control policy in Nepal.