Seven-year changes in the epidemiology of ESKAPE pathogens and their antimicrobial resistance in intensive care units of a tertiary hospital: a retrospective observational study

Background ESKAPE pathogens are the leading cause of hospital-acquired infections (HAIs) in intensive care units (ICUs) and are increasingly associated with multidrug resistance, posing a major challenge to patient management worldwide. This study evaluated seven-year changes in the epidemiology of ESKAPE pathogens and their antimicrobial resistance in ICUs of a tertiary hospital. Methods This retrospective observational surveillance study analysed microbiological isolates obtained from patients with hospital-acquired infections treated in the multidisciplinary ICU in 2017 and in the subsequently formed surgical and non-surgical ICUs in 2024 at least 48 h after admission to the ICU. The distribution of ESKAPE pathogens and antimicrobial susceptibility patterns were compared between study periods and ICU settings using χ 2 or Fisher's exact test, with statistical significance set at p < 0.05. Results A total of 1,113 microbiological isolates were analysed. ESKAPE pathogens accounted for more than 70% of microbiologically confirmed hospital-acquired infections in all investigated ICUs. Although their overall proportion remained stable over the seven-year period, the distribution of individual pathogens changed substantially. Acinetobacter baumannii remained the predominant pathogen in the multidisciplinary and non-surgical ICUs, whereas Klebsiella pneumoniae became the leading isolate in the surgical ICU. Antimicrobial resistance increased significantly, particularly among A. baumannii and K. pneumoniae. In 2024, carbapenem resistance in K. pneumoniae approached 75%, while A. baumannii exhibited resistance exceeding 75% to most routinely tested antimicrobial agents, leaving very limited therapeutic options. Conclusions Although the overall prevalence of ESKAPE pathogens remained relatively unchanged, significant shifts occurred in the distribution of individual pathogens together with a substantial increase in antimicrobial resistance over the seven-year period. Continuous local microbiological surveillance is essential for optimizing empirical antimicrobial therapy, supporting antimicrobial stewardship programs and strengthening infection prevention strategies in intensive care units.