Resistance prevalence and temporal trends of ESKAPE pathogens from clinical samples: a 5-year retrospective study at KCMC Tertiary Hospital, Tanzania

Antimicrobial resistance due to ESKAPE pathogens ( E. faecium , S. aureus , K. pneumoniae , A. baumannii , P. aeruginosa , Enterobacter spp. ) poses a critical global public health threat, especially in Sub-Saharan Africa. The present study aimed to investigate the epidemiological resistance prevalence and temporal trends (2019–2023) of ESKAPE pathogens and their antibiotic resistance patterns at KCMC Hospital in Northern Tanzania, providing data for the national AMR action plan. This 5-year retrospective study analysed 57,089 bacterial isolates recovered from 84,513 clinical samples collected at KCMC Hospital between 2019 and 2023. Of these bacterial isolates, 33,218 (58.2%) were identified as ESKAPE pathogens. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method and interpreted according to CLSI guidelines. Resistance patterns were summarised using organism- and antibiotic-specific denominators, with 95% confidence intervals calculated for key prevalence estimates. Temporal variation in resistance was assessed using appropriate categorical and trend analyses, with statistical significance defined as p < 0.05. Among all pathogens, 33,218 (58.2%) were ESKAPE pathogens. A high proportion of 14,712 (44.3%) isolates exhibited resistance across drug classes. The most prevalent pathogens were S. aureus (35.3%), K. pneumoniae (24.1%), and P. aeruginosa (20.0%). Temporal analysis showed a shift, with S. aureus prevalence decreasing (52% in 2019 to 25% in 2023) and P. aeruginosa increasing (14% to 27%). Isolates were primarily from blood (37.8%), pus (28.7%), and urine (23.8%). Critically, resistance to third-generation cephalosporins rose significantly in K. pneumoniae (20.2% to 40.1%) and A. baumannii (22.0% to 33.6%). ESKAPE pathogens, driven by increasing Gram-negative strains, represent a high burden of resistance at KCMC. The rising resistance to key antibiotics necessitates the urgent implementation of targeted antimicrobial stewardship and enhanced infection control measures in this tertiary care setting. Not applicable.