Identifying and quantifying ESKAPEE pathogens in and around sinks in high burden hospitals

Hospital-acquired infections driven by ESKAPEE pathogens ( <i>Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp</i> ., <i>and Escherichia coli</i> ) are highly prevalent. Premise plumbing, sinks and drains, seeds these organisms into patient environments via aerosolization and subsequent surface contamination. We measured viable ESKAPEE pathogens and overall microbial communities in and around sinks in two high-burden hospitals in La Paz, Bolivia, using culture and 16S rDNA sequencing. In a prospective observational study (May-August 2025), we collected 233 surface swabs and 39 air samples across four sink-related surface categories and in room air. Samples were plated on selective media for ESKAPEE identification and quantified as colony-forming units (CFU) normalized to 100 cm ² or 6000 L. DNA was extracted, and the full 16S rDNA gene was sequenced on PacBio Revio, analyzed via DADA2/QIIME2 and R. We detected viable presumptive ESKAPEE pathogens in 74.7% surface swabs and 74.4% air samples. Sink basins were most contaminated (mean 31CFU/100 cm ² , 95 % CI16-46); concentrations declined with distance from the drain. <i>Klebsiella</i> / <i>Enterobacter</i> spp. showed the highest mean concentration across samples; <i>S. aureus</i> was most frequently detected (54.4% of samples). Hospital-specific differences were evident in culture positivity (Hospital A 85% vs. Hospital B 66.9%) and community composition (PERMANOVA P = 0.001; sample location explained 21.9% vs. 11.7% of variation). 16S profiling confirmed elevated relative abundances of <i>Klebsiella, Enterococcus</i> , and <i>Enterobacter</i> in basins relative to distant surfaces and air. The hospitals studied had high levels of ESKAPEE pathogens, underscoring the need for control measures.