Prevalence of ESKAPEE pathogens as agents of healthcare-related infection in Brazil

This cross-sectional study analyzed medical records of intensive care unit (ICU) patients of an infectious disease hospital, Minas Gerais, Brazil, focusing on cases of healthcare-associated infections (HAIs) caused by bacteria from the ESKAPE group, an acronym for Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , Enterobacter spp., and Escherichia coli . Patients admitted to the ICU between January 1, 2017, and December 31, 2019, were included in this study. Of 1081 patients evaluated, 112 (10.4 %) were diagnosed with HAI, with 77 (68.7 %) cases involving bacteria from the ESKAPEE group. The average age of patients with HAI caused by ESKAPEE pathogens was 48.7 years ( ± 14.9), and all patients underwent at least one invasive procedure. Bloodstream infections were the most frequent, followed by respiratory tract infections. The most prevalent gram-negative bacterial species were Acinetobacter baumannii (30.6 %), Klebsiella pneumoniae (27 %), and Pseudomonas aeruginosa (27 %). The most frequently prescribed antimicrobial classes were glycopeptides and polymyxins. K. pneumoniae isolates (35 %) were resistant to imipenem and meropenem. Furthermore, approximately 90 % of A. baumannii and P. aeruginosa isolates exhibited resistance to several antimicrobials. Isolates of Enterobacter spp. were resistant to cefepime, ceftadizime, and ceftriaxone, while E. coli isolates were sensitive to imipenem and meropenem. ESKAPEE gram-positive bacteria causing HAIs were observed (21.3 %), with similar distribution between S. aureus and genus Enterococcus , in which the some isolated were resistant, respectively, to oxacillin and vancomycin. Multidrug-resistant bacteria, especially A. baumannii , was the most common, with simultaneous resistance to aminoglycosides, cephalosporins, and quinolones. Our results demonstrate a high frequency of HAI by bacteria from the ESKAPEE group. Therefore, strategies for the prevention, control and treatment of HAI caused by ESKAPEE are extremely important in the daily lives of professionals involved in patient care. • ESKAPEE bacteria cause the majority of healthcare-associated infections in ICUs. • Bloodstream infections were the most frequent. • The gram-negative bacterial species Acinetobacter baumannii was the most prevalent. • Vancomycin-resistant Enterococcus isolates were identified. • baumannii showed simultaneous resistance to aminoglycosides, cephalosporins, and quinolones.