Epidemiology, Antimicrobial Resistance, and Clinical Outcomes of the ESKAPE Pathogens at a Major Hospital in the UAE: A 10-Year Retrospective Cohort Study

Abstract

Bloodstream infections caused by ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pose a significant clinical and public health concern due to their multidrug-resistant profiles and associated morbidity and mortality. The purpose of this study was to analyze 10-year (2014–2023) patterns of epidemiological, antimicrobial resistance, and clinical outcomes of ESKAPE bloodstream infections at Sheikh Shakhbout Medical City (SSMC), the largest hospital in the United Arab Emirates. A retrospective review of laboratory and clinical data was performed to determine the frequency of isolates, resistance patterns, and outcomes before and after the initiation of a dedicated antimicrobial stewardship program in 2019. A total of 1,889 ESKAPE isolates were identified throughout the study period, where K. pneumoniae and S. aureus were the most common pathogens isolated. Regression analysis revealed significant downward trends in resistance among K. pneumoniae to the antimicrobials cefepime, ceftazidime, and ertapenem. P. aeruginosa showed decreasing resistance to both meropenem and imipenem, while S. aureus exhibited an increasing trend in resistance to moxifloxacin. Following the implementation of the hospital stewardship program, non-ESBL-producing K. pneumoniae showed a drop in median length of stay from 36 to 19 days and mortality from 34.1% to 21.3%; P. aeruginosa length of stay fell from 65 to 25 days with mortality decreasing from 50.5% to 35.2%; and A. baumannii mortality declined from 60.3% to 37.8%. These findings underscore the clinical and epidemiological impact of stewardship interventions and highlight the shifting resistance patterns of ESKAPE organisms in the UAE. They also demonstrate the broader value of stewardship programs in improving patient outcomes and preserving the effectiveness of critical antimicrobials in high-risk hospital settings.

Date of Award	2025
Original language	American English
Supervisor	Siobhan O'Sullivan (Supervisor)