Resistance Landscape and Clonal Dynamics of ESKAPE Pathogens in Bloodstream Infections: A Multicenter Study from Mexico
Antimicrobial resistance in healthcare-associated infections represents one of the greatest threats to global health. The COVID-19 pandemic disrupted infection control and antimicrobial stewardship, potentially affecting the prevalence of pathogens and the development of resistance. This study aimed to investigate the prevalence, antimicrobial resistance, and clonal dissemination of ESKAPE pathogens isolated from bloodstream infections during the second year of the COVID-19 pandemic in four tertiary-care hospitals in Mexico. A total of 926 isolates were analyzed: <i>Staphylococcus aureus</i> (22.4%), <i>Klebsiella pneumoniae</i> (22%), <i>Acinetobacter baumannii</i> (21.5%), <i>Pseudomonas aeruginosa</i> (12.5%), <i>Enterobacter cloacae</i> (9.4%), <i>Enterococcus faecalis</i> (8.4%), and <i>Enterococcus faecium</i> (3.8%). High rates of multidrug resistance were observed in <i>A. baumannii</i> (70.9% XDR) and <i>K. pneumoniae</i> (71% XDR plus MDR with 79% ESBL). <i>P. aeruginosa</i> and <i>E. cloacae</i> showed the highest susceptibility rates (53% and 48%, respectively) to all antimicrobials. The main β-lactamases involved in resistance were <i>bla</i><sub>SHV</sub>, <i>bla</i><sub>CTX-M</sub>, and <i>bla</i><sub>TEM</sub> in <i>K. pneumoniae,</i> while the predominant carbapenemases were <i>bla</i><sub>OXA-24</sub>, <i>bla<sub>OXA-23</sub> in A. baumannii, bla<sub>NDM</sub></i> in <i>K. pneumoniae,</i> and <i>bla</i><sub>VIM</sub> in <i>P. aeruginosa.</i> Among Gram-positives, methicillin-resistant <i>S. aureus</i> accounted for 33.8% of isolates, and vancomycin resistance was higher in <i>E. faecium</i> (28%) than in <i>E. faecalis</i> (1.3%). Pulsed-field gel electrophoresis revealed endemic circulation of <i>A. baumannii</i> clones (Pulsotypes 1AC, 2AM), persistent for over a decade, and interhospital dissemination of <i>S. aureus</i> and <i>K. pneumoniae</i> clones. These findings underscore the epidemiological relevance of MDR ESKAPE pathogens during the COVID-19 pandemic and highlight the urgent need to optimize empirical therapy and maintain continuous genomic surveillance to enhance infection control in Mexican hospitals.
Authors
- Rayo Morfín‐Otero (ORCID: https://orcid.org/0000-0001-9576-1950)
- Luis Fernando Pérez-González (ORCID: https://orcid.org/0000-0002-3646-2616)
- Catalina Gayosso-Vázquez (ORCID: https://orcid.org/0000-0002-5500-3423)
- Mónica Jazmín Osorio-Guzmán
- Manuelita Zavala-Pineda (ORCID: https://orcid.org/0009-0002-7888-8671)
- Andrés Flores (ORCID: https://orcid.org/0000-0001-5739-2939)
- Marı́a Dolores Alcántar-Curiel (ORCID: https://orcid.org/0000-0002-0761-1045)
- María Luisa Hernández-Medel (ORCID: https://orcid.org/0000-0003-1691-2920)
- Silvia Giono Cerezo (ORCID: https://orcid.org/0000-0003-1835-6788)
- María Angelina Quevedo-Ramos (ORCID: https://orcid.org/0000-0002-7181-9510)
- Miguel Ángel Morales-Gil
- Rodrigo Escobedo-Sánchez (ORCID: https://orcid.org/0009-0009-4473-8799)
- Ma Dolores Jarillo-Quijada (ORCID: https://orcid.org/0000-0003-4510-9707)
- Roberto Rosales-Reyes (ORCID: https://orcid.org/0000-0001-9519-8766)
- José Eduardo Toledano-Tableros (ORCID: https://orcid.org/0000-0002-5096-7864)
- Eduardo Rodríguez-Noriega (ORCID: https://orcid.org/0000-0002-1386-4815)
- José Ignacio Santos-Preciado (ORCID: https://orcid.org/0000-0001-9298-2926)
- Sergio Esparza-Ahumada (ORCID: https://orcid.org/0000-0002-6578-2432)
- José Luís Fernández-Vázquez (ORCID: https://orcid.org/0000-0001-6702-0899)
Institutions
- Universidad Autónoma de la Ciudad de México (MX)
- Universidad de Guadalajara (MX)
- Hospital General de México (MX)
- Hospital Central Dr. Ignacio Morones Prieto (MX)
- Hospital Civil de Guadalajara (MX)
- Universidad de León (MX)
- Hospital Universitario de León (ES)
- Instituto Politécnico Nacional (MX)
- Universidad Nacional Autónoma de México (MX)
Publication Details
- Journal
- Pathogens
- Published
- 2025-11-19
- DOI
- https://doi.org/10.3390/pathogens14111187
- Primary Topic
- Antibiotic Use and Resistance
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Instituto Politécnico Nacional
- Universidad Nacional Autónoma de México
- H2020 European Research Council