This retrospective study analyzed 14,625 isolates of the six major hospital-associated 'ESKAPE' pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) collected between 2002 and 2024 in a Hungarian tertiary-care center.Antimicrobial resistance was assessed using the antibiotic resistance index (ARI), multidrug resistance (MDR) ratios, and resistance instability index (RII).A. baumannii and E. faecium showed the highest resistance burdens and instability.Age showed a significant monotonic association with resistance (Spearman r = 0.88), with peaks in infants, middle-aged women, and the elderly.Species-specific age trends varied, with a negative correlation seen in Enterobacter spp.Hierarchical clustering grouped pathogens by resistance trajectory rather than taxonomy.Pairwise resistance distances confirmed divergence between Gram-positive and Gram-negative species.Resistance to aminoglycosides and sulfonamides showed the highest year-to-year variability, as quantified by the resistance instability index (RII), particularly in A. baumannii and E. faecium.VAR modeling predicted continued MDR increases in these species.A strong correlation was found between ARI and RII (Pearson r = 0.85, p = 0.032).These findings underscore the importance of integrating resistance magnitude and volatility in surveillance.
Sajerli et al. (Wed,) studied this question.
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