Prevalence and Antibiotic Resistance Profile of ESKAPE Pathogens in the Neonatal Intensive Care Unit of the Women and Newborn Hospital in Lusaka, Zambia

Prevalence and Antibiotic Resistance Profile of ESKAPE Pathogens in the Neonatal Intensive Care Unit of the Women and Newborn Hospital in Lusaka, Zambia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Antibiotic Resistance Profile of ESKAPE Pathogens in the Neonatal Intensive Care Unit of the Women and Newborn Hospital in Lusaka, Zambia Sharon Namukonda, Misheck Shawa, Amon Siame, James Mwansa, Mulundu Gina This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5327822/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Aug, 2025 Read the published version in Antimicrobial Resistance & Infection Control → Version 1 posted 9 You are reading this latest preprint version Abstract Background : The hospital environment serves as a significant reservoir of microorganisms, including multidrug-resistant (MDR) pathogens, which can lead to in-patient contamination and healthcare-associated infections (HAIs). MDR bacteria are predominantly found in Neonatal Intensive Care Unit (NICU) due to the frequent use of invasive medical devices, the variety of medical procedures performed, and the prolonged antibiotic treatments required by critically ill neonates. These factors, along with extended hospital stays, create an environment that fosters the development of MDR infections. Key pathogens involved in NICU-acquired infections such as E. faecium, S. aureus , K. pneumoniae , A. baumannii , P. aeruginosa , and Enterobacter sp ., are collectively known as ESKAPE pathogens. They are known for their antibiotic resistance, posing challenges for treatment. Methods : This was a cross-sectional study conducted from April 2023 to April 2024. The study aimed at investigating the contamination and antibiotic resistance profiles in the NICU at the Women and Newborn Hospital. A total of 344 Samples were collected from different inanimate objects including baby bodies, baby tubes, and mother's hands using sterile moistened swabs. Bacterial isolates were identified using standard microbiological procedures and antimicrobial susceptibility testing was performed using the Kirby-Bauer method. Results : bacterial contamination rate was (93.9%), with 25.7% of samples containing ESKAPE pathogens. K. pneumoniae was the most prevalent bacteria with the most isolates found on mother’s hands. Antimicrobial susceptibility varied among ESKAPE pathogens with a total of 75 (90%) of the 83 ESKAPE isolates MDR. Gram-negative pathogens were highly susceptible to gentamicin and amikacin but showed significant resistance to aztreonam, piperacillin tazobactam, and meropenem. Gram-positive pathogens were susceptible to gentamicin, linezolid, vancomycin, and clindamycin, but resistant to penicillin, cefotaxime, and erythromycin. Conclusion : There was a high bacterial contamination and MDR ESKAPE pathogens in the NICU. Given that most of the isolates were susceptible to gentamicin and amikacin, there should be continued monitoring and judicious use of gentamicin and amikacin to curb antibiotic resistance development. Prevalence ESKAPE Pathogens Antibiotic Resistance and Neonatal Intensive Care Unit Figures Figure 1 Figure 2 Figure 3 INTRODUCTION The hospital environment is a known reservoir for microorganisms, including multidrug-resistant (MDR) pathogens, which are implicated in healthcare-associated infections (HAIs).( 1 )( 2 ) ( 3 ). In the Neonatal Intensive Care Unit (NICU), bacterial contamination poses a significant risk for cross-transmission, potentially leading to infections in vulnerable neonate( 4 ) Neonates in the NICU are particularly susceptible to infections due to their underdeveloped immune systems, compromised skin barriers, and critical medical conditions, which often necessitate invasive procedures.( 5 ) This vulnerability is exacerbated in low- and middle-income countries (LMICs), where the risk of acquiring HAIs is 20 times higher than in high-income settings. ( 6 ) The pathogens frequently associated with NICU infections include ESKAPE pathogens namely Enterococcus faecium, Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii, Pseudomonas aeruginosa , and Enterobacter sp . These MDR pathogens, often labelled as "superbugs," are prioritized by the World Health Organization due to the need for new antibiotics to combat them. ( 7 ). Evidence suggests that contaminated inanimate surfaces and medical equipment in NICUs play a role in harbouring these resistant strains.( 8 )( 2 ) This contamination poses risks to both patients and staff, particularly given the high mortality rates associated with infections caused by these pathogens and the limited treatment options available. In Sub-Saharan Africa, studies have reported a high prevalence of bacterial contamination in NICUs, including 74.7% in Ethiopia( 9 ) and 86.2% in Zimbabwe( 10 ) Staphylococcus aureus and K. pneumoniae were the most frequently isolated pathogens in these regions. In Zambia, the University Teaching Hospital (UTH) has been documented to have an increase in antimicrobial resistance (AMR) among bacteria from clinical samples( 11 ) Previous studies have reported sepsis by MDR K. pneumoniae to be the leading cause of death in the NICU at UTH.( 12 – 14 ). this emphasizes the need for continuous assessment of this pathogen's threat; however, it is equally important to investigate if other MDR ESKAPE pathogens are emerging which could potentially compromise treatment efficacy and infection control strategies. This study was undertaken to determine the level of bacterial contamination and antibiotic resistance patterns of ESKAPE pathogens isolated from commonly touched inanimate objects, baby bodies, baby tubes and mother’s hands in the NICU of the Women and Newborn (WNH) of UTH in Lusaka, Zambia. The findings of this study are essential for guiding more effective infection control protocols and ensuring optimal treatment outcomes for vulnerable preterm infants. METHODOLOGY Study design and area This was a cross-sectional laboratory-based study that focused on determining contamination and resistance patterns of ESKAPE pathogens isolated from the environment of NICU of the WNH in Lusaka, Zambia. Sampling procedure Sampling focused on surfaces and equipment that come into contact with healthcare professionals and neonates. A total of 344 swabs were collected randomly from different rooms of the NICU. Swabs were collected from neonate’s bodies and mother’s hands. Baby tubes such as nasal gastric tubes and nasal cannulas, were also swabbed after use, as well as the floors of every room. Using standard aseptic techniques, surfaces like infant warmers, sink taps, oxygen concentrators, benches, bed rails, and incubators and table tops were swabbed with sterile, moistened swabs. For flat surfaces, such as incubators and counters, a 12 cm² area was swabbed, with the swab rolled over the surface three times to ensure full coverage. Surface controls were used for comparison, and each sample was labelled with the swabbing site, date, and time. All samples were placed in Amies transport media and transported to the UTH Microbiology Laboratory within two hours for analysis. Culture and identification Each specimen was inoculated on three different culture media (Blood agar, Chocolate agar and MacConkey agar) using sterile wire loops and incubated at 37 o C for 48 hours. Identification of ESKAPE pathogens was made initially by Gram stain and colony morphology followed by biochemical tests. Confirmation was done using the Vitek 2 compact machine Antimicrobial susceptibility testing Antimicrobial susceptibility testing was carried out on selected bacterial isolates using the Kirby-Bauer disk diffusion method on Mueller Hinton agar. Antimicrobial impregnated disks were placed using sterile forceps on the agar surface and incubated at 37 o C for 24 hours. The zone diameters were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) 2021 guideline as susceptible (S), intermediate (I) or resistant (R). Statistical Analysis Data was checked for completeness, coded, and entered onto Excel version 10 and transferred to the Statistical Package for the Social Science (SPSS) version 20 for analysis. All variables were presented as descriptive and inferential statistics. ETHICAL CONSIDERATIONS Ethical approval was obtained from the University of Zambia Biomedical Research Ethics Committee (UNZABREC) (REF. 3175-2022) and the National Health Research Authority (NHRA). Permission to conduct a study at the WNH was sought from the Senior Medical Superintendent. Ascent to swab baby bodies was gotten from the mothers as well as consent to swab their hands. Participants were assured of confidentiality as well as anonymity. RESULTS Microbial Growth and Prevalence of ESKAPE Pathogens from 344 Surface Swabs Results showed that out of 344 surface swabs obtained from NICU, 323 (93.9%) samples had bacterial growth, while the remaining 21 (6.1%) swabs did not show any bacterial growth. The prevalence of ESKAPE pathogens was 83/344 (24.1%), with 240/344 (69.8%) being bacterial growth other than ESKAPE pathogens. As shown in Fig. 1 below. Figure 2 below shows the proportion of the ESKAPE pathogens following stratification. The results showed that majority of the ESKAPE pathogens isolated was K. pneumoniae at 33 (39.8%), followed by A. baumannii 24 (29.0%), while the least isolated bacteria were P. aeruginosa 3 (3.6%). Profile and Distribution of Bacteria isolated from the samples Results showed that mother’s hands had the highest bacterial contamination of ESKAPE pathogens at 12 (14.5%) with K. pneumoniae being the most frequent at 8 (24.2%). Baby body and baby catheter tubes had 16 (19.3%) and 12 (14.3%) respectively. S. aureus was mostly isolated from the baby body (42.9%), and A. baumannii from the baby tube (25.0%). Table 1 Distribution of ESKAPE Pathogens by Source of Specimen Site of Sampling ESKAPE Pathogens K. pneumoniae A. baumannii E. faecium Enterobacter sp S. aureus P. aeruginosa Total Baby Body 5 (15.1%) 5 (20.8%) 2 (22.2%) 1 (14.2%) 3 (42.9%) 1 (33.3%) 16 (19.3%) Bed rail 2 (6.1%) 1 (4.2%) 0 0 0 0 3 (3.6%) Baby tube 5 (15.2%) 6 (25.0%) 0 1 (14.2%) 0 0 12 (14.3%) Oxygen Concentrator Concentration water 1 (3.0%) 2 (6.1%) 0 2 (8.3%) 0 0 0 0 0 0 1 (33.3%) 0 2 (2.4%) 4 (4.8%) Bin 0 0 1 (11.1%) 0 0 1 (33.3%) 2 (2.4%) Mother’s Hands 8 (24.2%) 4 (16.7%) 0 0 0 0 12 (14.5%) Floor 2 (6.1%) 0 1 (11.1%) 2 (28.6%) 1 (14.2%) 0 6 (7.2%) Sink 1 (3.0%) 2 (8.3%) 0 0 1 (14.2%) 0 4 (4.8%) Cup (milk room) 2 (6.0%) 0 0 0 0 0 2 (2.4%) Incubator 0 0 0 0 1 (14.2%) 0 1 (1.2%) Bench 1 (3.0%) 1 (4.2%) 0 1 (14.2%) 1 (14.2%) 0 4 (4.8%) Air Sample 2 (6.0%) 1 (4.2%) 2 (22.2%) 0 0 0 5 (6.0%) Suction Machine 3 (9.1%) 0 0 0 0 0 3 (3.6%) Infant Warmer 0 1 (4.2%) 1 (11.1%) 0 0 0 2 (2.4%) Book 0 0 2 (22.2%) 1 (14.2%) 0 0 3 (3.6%) Table Top 0 0 0 1 (14.2%) 0 0 1 (1.2%) Bed underside 0 1 (4.2%) 0 0 0 0 1 (1.2%) TOTAL 33 24 9 7 7 3 83 Antibiotic Resistance Pattern of ESKAPE Pathogens Table 2 shows resistance patterns of Gram-Negative pathogens. The resistance patterns observed indicate that Enterobacter sp showed high resistance to aztreonam 6/7 (86.7%) and meropenem6/7 (86.7%). K. pneumoniae exhibited significant resistance to cotrimoxazole 33/33 (100%), cefepime 32/33 (97.0%), aztreonam 30/33 (90.9%) and ceftazidime 31/33 (94.0%). In addition, of the 31 K. pneumoniae strains tested for ESBL, 15/31 (48.4%) were positive. Importantly, most of the K. pneumoniae strains were resistant to meropenem. A. baumannii was highly resistant to aztreonam 24/24 (100%), ceftriaxone 17/24 (70.8%), ceftazidime 22/24 (91.7%), and cefepime 16/24 (66.7%). P. aeruginosa displayed resistance to aztreonam (66.7%) and meropenem (66.7%). Table 2 Antimicrobial Resistant Patterns of Gram-Negative ESKAPE Pathogens Antibiotics Enterobacter sp (n = 7) K. pneumoniae (n = 33) A. baumannii (n = 24) P. aeruginosa (n = 3) Total (n = 67) n (%) n (%) n (%) n (%) n (%) Amikacin 3 (42.9%) 2 (6.1%) 9 (37.5%) 1 (33.3%) 14 (20.9%) Ampicillin/sulbactam 5 (71.4%) 28 (84.8%) 8 (33,3%) 0 (0%) 41 (61.2%) Aztreonam 6 (86.7%) 30 (90.9%) 24 (100%) 2 (66.7%) 62 (92.5%) Ciprofloxacin 3 (42.9%) 2 (6.1%) 1 (4.2%) 1 (33.3%) 7 (10.4%) Ceftriaxone 5 (71.4%) 32 (97.0%) 17 (70.8%) NT 35 (52.2%) Ceftazidime 5 (71.4%) 31 (94.0%) 22 (91.7%) 1 (33.3%) 59 (88.1%) Cotrimoxazole 5 (71.4%) 33 (100%) 7 (29.2%) NT 45 (67.2%) Cefepime 3 (42.9%) 32 (97.0%) 16 (66.7%) 1 (33.3%) 52 (77.6%) Gentamicin 1 (14.3%) 11 (33.3%) 2 (8.2%) 1 (33.3%) 15 (22.4%) Meropenem 6 (86.7%) 29 (87.9%) 15 (62.5%) 2 (66.7%) 52 (77.6%) Piperacillin/Tazobactam 0 (0%) 12 (36.4%) 9 (37.5%) 0 (0%) 21 (31.3%) Tetracycline NT 1 (3%) 10 (41.7%) NT 11 (16.4%) NT = ANTIBIOTIC NOT TESTED Table 3 shows antibiotic resistance patterns of S. aureus and enterococcus sp. Notably, 5/7 (71.4%) S. aureus exhibited resistance to cefoxitin, thus classified as methicillin-resistant S. aureus (MRSA). Expectedly, all five 5/5 (100%) MRSA strains were resistant to penicillin E. faecium exhibited high resistance to linezolid (88.9%), tetracycline (88.9%), penicillin (77.8%), erythromycin (77.8%), ciprofloxacin (77.8%) and chloramphenicol (77.7%) Table 3 Antibiotics Resistant Pattern of Gram-Positive ESKAPE Pathogens Antibiotics S. aureus (n = 7) E. faecium (n = 9) Total (n = 16) n (%) n (%) n (%) Penicillin G 5 (71.4%) 7 (77.8%) 12 (75%) Ampicillin NT 1 (11.1%) 1 (11.1%) Cefoxitin 5 (71.4%) NT 5 (71.4%) Erythromycin 3 (42.9%) 7 (77.8%) 10 (62.5%) Chloramphenicol 1 (14.3%) 6 (77.7%) 7 (43.8%) Nitrofurantoin NT 7 (77.8%) 7 (43.8%) Linezolid 1 (14.3%) 8 (88.9%) 9 (56.3%) Ciprofloxacin 2 (28.6%) 7 (77.8%) 9 (56.3%) Vancomycin NT 3 (33.3%) 3 (18.8%) Cotrimoxazole 5(71.4%) NT 2 (28.6%) Tetracycline 1 (14.3%) 8 (88.9%) 9 (56.3%) Gentamicin 0 (0%) NT 0 (0%) Clindamycin 4 (57.1%) NT 4 (56.2%) NT = Antibiotic Not Tested Figure 3 shows the antibiotic susceptibility patterns observed as follows: Enterobacter sp were highly susceptible to tetracycline (100%), piperacillin/tazobactam (71.4%), and gentamicin (71.4%). K. pneumoniae demonstrated high susceptibility to amikacin (87.9%) and gentamicin (60.6%). A. baumannii showed high susceptibility to gentamicin (91.7%) and amikacin (50%). P. aeruginosa exhibited susceptibility to ampicillin/sulbactam, ciprofloxacin, ceftazidime, and gentamicin (all 66.7%). S. aureus was highly susceptible to gentamicin (100%), linezolid (85.7%), clindamycin (85.7%), and chloramphenicol (85.7%). E. faecium showed moderate susceptibility to vancomycin (55.6%). DISCUSSION Bacterial Contamination and Prevalence of ESKAPE Pathogens The bacterial contamination rate in the NICU was notably high, which indicates a critical issue in the environment from which samples were taken. Studies from various parts of the globe reported similar findings, showing that hospitals often experience high bacterial contamination.( 8 )( 15 ) ( 16 ). This contamination often arises from bacteria shed by patients, visitors, and healthcare workers, leading to an increased risk of infection among vulnerable patients.( 17 ) The current study shows presence of ESKAPE pathogens, particularly on items that are supposed to be sterile, such as milk cups and in oxygen concentration water suggesting that sterilization methods may be insufficient. The presence of ESKAPE on item that are supposed to be sterile could also indicate that the pathogens maybe resistant to the disinfectants being used. Studies have reported bacterial resistance to disinfectants, especially biofilm-producing bacteria like A. baumannii , which can withstand harsh conditions( 18 ) ( 19 ). However, isolates from the current study were not tested for resistance to disinfectants The current study revealed a high prevalence of bacterial contamination in the NICU, with 93.9% of surface swabs showing bacterial growth. Of these, 24.1 were ESKAPE pathogens. The most frequently isolated bacteria were K. pneumoniae , followed by A. baumannii , which aligns with a similar study in the NICU of Mpilo Hospital ( 16 ). In contrast S. aureus was identified by previous studies as the most common bacteria in their NICU, indicating that different hospital wards may harbor varying bacterial populations. ( 20 ). The isolation of ESKAPE pathogens from NICU surfaces is concerning. Newborn babies are susceptible to infections; thus, their environment should be safe from pathogens. Standard cleaning procedures involve using sterilized gowns and shoes, hand washing with soap, and using disinfected medical equipment. In addition, floors and surfaces should be disinfected frequently and quality checks performed regularly. However, some hospitals in developing countries may not always meet the minimum standards. The current study has revealed that despite the implementation of an Infection Prevention and Control bundle (IPC) in the NICU at UTH, ESKAPE pathogens particularly Klebsiella pneumoniae and Acinetobacter baumannii are still prevalent ( 21 ). This persistent contamination highlights the challenges in resource-limited settings, where constraints in space, staffing, and funding hinder the full implementation of traditional IPC measures ( 22 ). The current study findings have shown the mother’s hands contained the highest number of ESKAPE pathogens (14.5%) of which K. pneumoniae was the most isolated (66.7%). This is concerning because these mothers are the ones caring for their immunocompromised infants. A previous study to assess hygiene practices of mothers of the NICU at UTH reported that the mothers showed limited consistency in hygiene practices ( 21 ). The current study suggests a lack of good hygiene practices by the mothers. It could also indicate inadequately prepared hand disinfectants or K. pneumoniae being resistant to the hand disinfectants provided in the NICU. It is therefore important to note that apart from health care workers, mothers and cleaners are also crucial in driving and sustaining the process to reduce environmental contamination. Antimicrobial Resistance Patterns of ESKAPE Pathogens The study revealed variable antimicrobial susceptibility patterns among ESKAPE pathogens. Most of the ESKAPE isolates were susceptible to amikacin and gentamicin. These results are similar to previous studies that reported similar results ( 23 , 24 ). Resistance to ampicillin was present in all tested isolates, regardless of species. Based on a previous study it can be speculated that Extended spectrum beta lactamases (ESBLs) are responsible for the observed pattern ( 25 ). This is supported by the high resistance to third-generation cephalosporins tested in this study. K. pneumoniae isolates in this study were positive for phenotypic ESBL. Also, most of the isolates exhibited resistance to the drug class of last resort, meropenem. However, most meropenem-resistant strains though MDR were generally susceptible to gentamicin or amikacin. This is in contrast to a study that reported some resistance to aminoglycosides but complete susceptibility to trimethoprim ( 26 ). A previous study in the NICU reported resistance to gentamicin but susceptibility to amikacin and imipenem. ( 27 ). This observed difference in antibiotic susceptibility patterns despite the results from being obtained from the same NICU could be due to variations in infection control, antibiotic use, sampling periods, or sub clonal populations, reflecting the evolving nature of antimicrobial resistance. A. baumannii showed susceptibility to gentamicin and amikacin but resistance to aztreonam and ceftazidime. These results are consistent with a previous study which observed similar trends in A. baumannii susceptibility patterns. ( 28 ) . Enterobacter sp isolates were susceptible to tetracycline, gentamicin, and piperacillin/tazobactam, but resistant to amikacin, aztreonam, and meropenem. This pattern is consistent with previous research on Enterobacter sp ( 29 ). The findings therefore show the importance of tailored antibiotic therapy in managing infections in the NICU, particularly with drug-resistant pathogens P. aeruginosa was less prevalent but exhibited resistance to aztreonam and meropenem, while remaining susceptible to ampicillin/sulbactam, ciprofloxacin, and gentamicin. This is contrast to a previous study that reported P.aeruginosa to be resistant to ciprofloxacin and another study which reported its susceptibility to piperacillin-tazobactam ( 30 , 31 ) Similarly, S. aureus isolates were highly susceptible to gentamicin and ciprofloxacin but resistant to penicillin and cefoxitin, indicating the presence of MRSA. The detection of cefoxitin resistance is significant because it indicates that these isolates have the mecA gene, which is responsible for altering penicillin-binding proteins and thereby conferring resistance to methicillin and related antibiotics. This agrees with a study that reported that methicillin-resistant Staphylococcus aureus (MRSA) strains are often resistant to beta-lactams but susceptible to non-beta-lactam antibiotics like linezolid and gentamicin ( 32 ). The antibiotic resistance results for E. faecium reveal a concerning pattern, with 88.9% of isolates resistant to linezolid and 33.3% resistant to vancomycin. Linezolid is often used as a last-resort antibiotic for treating MDR Gram-positive infections, so high resistance rates severely limit therapeutic options for treating E. faecium infections. The presence of vancomycin resistance further complicates treatment, as it indicates the potential for the spread of resistance to other critical pathogens such as S. aureus resulting in Vancomycin-resistance S. aureus (VRSA)(33) Finally, the study has reported variability in the susceptibility and resistance of different strains of bacteria to antimicrobial agents. These findings highlight the significance of antibiotic stewardship programs in healthcare settings to optimize antibiotic use and minimize the emergence of resistance. By understanding the resistance patterns of bacterial pathogens, healthcare providers can make informed decisions regarding antibiotic selection, dosage, and duration of therapy, ultimately improving patient outcomes and mitigating the spread of antimicrobial resistance LIMITATIONS OF THE STUDY We could not ascertain the clonality of the isolated pathogens; therefore, we have not elucidated the spread dynamics of the observed AMR. Whole-genome-based analysis will be necessary to compare sequence types, OH serotypes, plasmid replicons, and AMR genes. Furthermore, whole-genome sequencing will unravel the mechanisms of carbapenem resistance (i.e., plasmid-borne carbapenemase genes or point mutations) and provide insight into the control options. CONCLUSION The study highlights the widespread contamination of NICU environment by ESKAPE pathogens, particularly K. pneumoniae and A. baumannii , which were frequently found on mothers’ hands, baby bodies, and baby tubes. High contamination was also noted on the floor and commonly used equipment like oxygen concentrators. These pathogens exhibited significant resistance to multiple antibiotics which poses challenges for treatment and calls for alternative therapeutic options. P. aeruginosa showed susceptibility to most antibiotics, although some resistance was observed, warranting continuous resistance surveillance. While S. aureus showed susceptibility to antibiotics like gentamicin and linezolid, it was MRSA indicating resistance to most beta lactams. E. faecium demonstrated resistance to several antibiotics but remained susceptible to vancomycin. These findings emphasize the critical need for improved hygiene practices, rigorous infection control, and antimicrobial stewardship to combat the spread of antibiotic-resistant pathogens in the NICU. Abbreviations CDC : Centre for Disease Control CFU : Colony Forming Units CoNS : Coagulase-negative Staphylococcus ESBL : Extended Spectrum Beta-Lactamase GNB : Gram-negative Bacterial HAI : Healthcare-Associated Infections HCW : Healthcare workers ICU : Intensive Care Unit LMIC : Low to Middle-income Countries MDR : Multi-Drug Resistance MDRO: Multi-Drug-Resistant Organisms MRSA : Methicillin Resistance S. Aureus NI : Nosocomial Infections NICU : Neonatal Intensive Care Unit VRSA : Vacomycin-reistant S. aureus WHO : World Health Organization Declarations Competing interests The author declares that they have no competing interests Competing interest The authors declare that they have no competing interests. Funding This study was partially funded by the ministry of science and technology Author Contribution SN, as a principal investigator, designed the study, collected and processed the specimens, and drafted the manuscript. AS contributed to the design of the study, data analysis and refined the manuscript. MS, JM and GM contributed to design of the study, formulated the objectives and refined the manuscript. All authors have read and approved the final manuscript. Acknowledgements Many thanks to the staff members of the NICU of the WNH as well the mothers who participated in the research. and the Bacteriology Laboratory for all their valuable support. Gratitude goes to the Ministry of Science and technology for the financial support. Availability of data and materials Please contact author for data request. References Ogunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - A narrative review. Vol. 9, Antimicrobial Resistance and Infection Control. BioMed Central; 2020. Rodrigues DO, Peixoto L da P, Barros ETM, Guimaraes JR, Gontijo BC, Almeida JL, et al. 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Prevalence of Infections and Antimicrobial Resistance of ESKAPE Group Bacteria Isolated from Patients Admitted to the Intensive Care Unit of a County Emergency Hospital in Romania. Antibiotics. 2024;13(5). Mumbula EM, Kwenda G, Samutela MT. Extended Spectrum β-Lactamases Producing Klebsiella pneumoniae from the Neonatal Intensive Care Unit at the University Teaching Hospital in Lusaka, Zambia. Vol. 4, Jour of Med Sc & Tech. 2015. Nair V, Sahni AK, Sharma D, Grover N, Shankar S, Chakravarty A, et al. Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India. Indian Journal of Medical Research. 2017 Jun 1;145(June):824–32. Cataño JC, Echeverri LM, Szela C. Bacterial contamination of clothes and environmental items in a third-level hospital in Colombia. Interdiscip Perspect Infect Dis. 2012;2012. Pandey R, Mishra SK, Shrestha A. Characterisation of eskape pathogens with special reference to multidrug resistance and biofilm production in a nepalese hospital. Infect Drug Resist. 2021;14:2201–12. Azimi L, Fallah F, Karimi A, Shirvani F, Tehrani NA, Armin S, et al. Prevalence and Antimicrobial Resistance Patterns in ESKAPE Pathogens in Iran. Arch Pediatr Infect Dis. 2023;11(1). Navidinia M, Goudarzi M, Rameshe SM, Farajollahi Z, Asl PE, Khosravi SZ, et al. Molecular characterization of resistance genes in MDR-ESKAPE pathogens. J Pure Appl Microbiol. 2017 Jun 1;11(2):779–92. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Aug, 2025 Read the published version in Antimicrobial Resistance & Infection Control → Version 1 posted Editorial decision: Revision requested 10 Mar, 2025 Reviews received at journal 09 Mar, 2025 Reviews received at journal 14 Dec, 2024 Reviewers agreed at journal 06 Dec, 2024 Reviewers agreed at journal 29 Nov, 2024 Reviewers invited by journal 26 Nov, 2024 Editor assigned by journal 29 Oct, 2024 Submission checks completed at journal 29 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5327822","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371567767,"identity":"16c4f226-d8f5-4a5b-8149-5a61a8c98358","order_by":0,"name":"Sharon Namukonda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACCTiLDYzlQMwDD0jRYgzWkkCKlsQGEBufFvnZzc8+fNxhl6c7Iy3xcUGZXfr8sMMPgbbYyek2YNdicOeY8cyZZ5KLzW6kHTaecS45d+PtNAOglmRjswM4tEgkGDPztjEnbruR3iYNZORunJ0A0nIgcRsOLfIz0j8DtdTDtNSnG85O/4BXC8ONHJAth4Fa0o4BtRxOkJfOwW+LwY2cYsaZbccTt515lmzMc+644QbpnIIDCQa4/QJ02GaGj23ViduOpxk+5imrlpefnb75w4cKOzlcWrDYC1ZpQKxysL0NpKgeBaNgFIyCkQAA5tRi2rouSkMAAAAASUVORK5CYII=","orcid":"","institution":"University of Zambia","correspondingAuthor":true,"prefix":"","firstName":"Sharon","middleName":"","lastName":"Namukonda","suffix":""},{"id":371567768,"identity":"4388b3f4-1bce-4263-b73e-c33f041e6cb0","order_by":1,"name":"Misheck Shawa","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Misheck","middleName":"","lastName":"Shawa","suffix":""},{"id":371567769,"identity":"2784ae28-2eb1-4878-95d0-25bd62c3f3ab","order_by":2,"name":"Amon Siame","email":"","orcid":"","institution":"University of Zambia","correspondingAuthor":false,"prefix":"","firstName":"Amon","middleName":"","lastName":"Siame","suffix":""},{"id":371567770,"identity":"3147754a-8d96-4d6f-aea5-fff05bbe1f68","order_by":3,"name":"James Mwansa","email":"","orcid":"","institution":"Lusaka Apex Medical University","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Mwansa","suffix":""},{"id":371567771,"identity":"28bbbc9c-7817-4962-bbb8-ed6b0ac40613","order_by":4,"name":"Mulundu Gina","email":"","orcid":"","institution":"University of Zambia","correspondingAuthor":false,"prefix":"","firstName":"Mulundu","middleName":"","lastName":"Gina","suffix":""}],"badges":[],"createdAt":"2024-10-24 18:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5327822/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5327822/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13756-025-01588-5","type":"published","date":"2025-08-05T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69360190,"identity":"4e08813c-0a02-44c2-81bd-9e6db1c08763","added_by":"auto","created_at":"2024-11-19 14:15:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43021,"visible":true,"origin":"","legend":"\u003cp\u003eA Bar Chart Showing Results of Culture of 344 Surface Swabs from NICU\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5327822/v1/43ac94fbccb94307b98c0297.png"},{"id":69360189,"identity":"82fe4434-914d-4468-baad-760b08b3dabd","added_by":"auto","created_at":"2024-11-19 14:15:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":48951,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of ESKAPE Pathogens Isolated from NICU, UTH\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5327822/v1/fab9063d062014cd12d5532f.png"},{"id":69361155,"identity":"270b46e2-12fa-496a-bb35-f84dc9f9fa3b","added_by":"auto","created_at":"2024-11-19 14:23:47","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":368239,"visible":true,"origin":"","legend":"\u003cp\u003eHeat Map Showing Total Antimicrobial Susceptibility Patterns of 83 ESKAPE Pathogens\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5327822/v1/b845c8cce12d514af027bc5e.png"},{"id":88814160,"identity":"73733009-7d6f-4ef7-a7b9-0bd039d047d0","added_by":"auto","created_at":"2025-08-11 16:07:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1367129,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5327822/v1/0513f870-b9ff-43d7-8008-2cab523b01a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Antibiotic Resistance Profile of ESKAPE Pathogens in the Neonatal Intensive Care Unit of the Women and Newborn Hospital in Lusaka, Zambia","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe hospital environment is a known reservoir for microorganisms, including multidrug-resistant (MDR) pathogens, which are implicated in healthcare-associated infections (HAIs).(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In the Neonatal Intensive Care Unit (NICU), bacterial contamination poses a significant risk for cross-transmission, potentially leading to infections in vulnerable neonate(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Neonates in the NICU are particularly susceptible to infections due to their underdeveloped immune systems, compromised skin barriers, and critical medical conditions, which often necessitate invasive procedures.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) This vulnerability is exacerbated in low- and middle-income countries (LMICs), where the risk of acquiring HAIs is 20 times higher than in high-income settings. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe pathogens frequently associated with NICU infections include ESKAPE pathogens namely \u003cem\u003eEnterococcus faecium, Staphylococcus aureus\u003c/em\u003e, \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eAcinetobacter baumannii, Pseudomonas aeruginosa\u003c/em\u003e, and \u003cem\u003eEnterobacter sp\u003c/em\u003e. These MDR pathogens, often labelled as \"superbugs,\" are prioritized by the World Health Organization due to the need for new antibiotics to combat them. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Evidence suggests that contaminated inanimate surfaces and medical equipment in NICUs play a role in harbouring these resistant strains.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) This contamination poses risks to both patients and staff, particularly given the high mortality rates associated with infections caused by these pathogens and the limited treatment options available.\u003c/p\u003e \u003cp\u003eIn Sub-Saharan Africa, studies have reported a high prevalence of bacterial contamination in NICUs, including 74.7% in Ethiopia(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and 86.2% in Zimbabwe(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eK. pneumoniae\u003c/em\u003e were the most frequently isolated pathogens in these regions. In Zambia, the University Teaching Hospital (UTH) has been documented to have an increase in antimicrobial resistance (AMR) among bacteria from clinical samples(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Previous studies have reported sepsis by MDR \u003cem\u003eK.\u003c/em\u003e pneumoniae to be the leading cause of death in the NICU at UTH.(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). this emphasizes the need for continuous assessment of this pathogen's threat; however, it is equally important to investigate if other MDR ESKAPE pathogens are emerging which could potentially compromise treatment efficacy and infection control strategies.\u003c/p\u003e \u003cp\u003eThis study was undertaken to determine the level of bacterial contamination and antibiotic resistance patterns of ESKAPE pathogens isolated from commonly touched inanimate objects, baby bodies, baby tubes and mother\u0026rsquo;s hands in the NICU of the Women and Newborn (WNH) of UTH in Lusaka, Zambia. The findings of this study are essential for guiding more effective infection control protocols and ensuring optimal treatment outcomes for vulnerable preterm infants.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cem\u003eStudy design and area\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional laboratory-based study that focused on determining contamination and resistance patterns of ESKAPE pathogens isolated from the environment of NICU of the WNH in Lusaka, Zambia.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSampling procedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSampling focused on surfaces and equipment that come into contact with healthcare professionals and neonates. A total of 344 swabs were collected randomly from different rooms of the NICU. Swabs were collected from neonate\u0026rsquo;s bodies and mother\u0026rsquo;s hands. Baby tubes such as nasal gastric tubes and nasal cannulas, were also swabbed after use, as well as the floors of every room. Using standard aseptic techniques, surfaces like infant warmers, sink taps, oxygen concentrators, benches, bed rails, and incubators and table tops were swabbed with sterile, moistened swabs. For flat surfaces, such as incubators and counters, a 12 cm\u0026sup2; area was swabbed, with the swab rolled over the surface three times to ensure full coverage. Surface controls were used for comparison, and each sample was labelled with the swabbing site, date, and time. All samples were placed in Amies transport media and transported to the UTH Microbiology Laboratory within two hours for analysis.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCulture and identification\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach specimen was inoculated on three different culture media (Blood agar, Chocolate agar and MacConkey agar) using sterile wire loops and incubated at 37\u003csup\u003eo\u003c/sup\u003eC for 48 hours. Identification of ESKAPE pathogens was made initially by Gram stain and colony morphology followed by biochemical tests. Confirmation was done using the Vitek 2 compact machine\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAntimicrobial susceptibility testing\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAntimicrobial susceptibility testing was carried out on selected bacterial isolates using the Kirby-Bauer disk diffusion method on Mueller Hinton agar. Antimicrobial impregnated disks were placed using sterile forceps on the agar surface and incubated at 37\u003csup\u003eo\u003c/sup\u003e C for 24 hours. The zone diameters were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) 2021 guideline as susceptible (S), intermediate (I) or resistant (R).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData was checked for completeness, coded, and entered onto Excel version 10 and transferred to the Statistical Package for the Social Science (SPSS) version 20 for analysis. All variables were presented as descriptive and inferential statistics. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eETHICAL CONSIDERATIONS\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the University of Zambia Biomedical Research Ethics Committee (UNZABREC) (REF. 3175-2022) and the National Health Research Authority (NHRA). Permission to conduct a study at the WNH was sought from the Senior Medical Superintendent. Ascent to swab baby bodies was gotten from the mothers as well as consent to swab their hands. Participants were assured of confidentiality as well as anonymity.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eMicrobial Growth and Prevalence of ESKAPE Pathogens from 344 Surface Swabs\u003c/h2\u003e \u003cp\u003eResults showed that out of 344 surface swabs obtained from NICU, 323 (93.9%) samples had bacterial growth, while the remaining 21 (6.1%) swabs did not show any bacterial growth. The prevalence of ESKAPE pathogens was 83/344 (24.1%), with 240/344 (69.8%) being bacterial growth other than ESKAPE pathogens. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below shows the proportion of the ESKAPE pathogens following stratification. The results showed that majority of the ESKAPE pathogens isolated was \u003cem\u003eK. pneumoniae\u003c/em\u003e at 33 (39.8%), followed by \u003cem\u003eA. baumannii\u003c/em\u003e 24 (29.0%), while the least isolated bacteria were \u003cem\u003eP. aeruginosa\u003c/em\u003e 3 (3.6%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eProfile and Distribution of Bacteria isolated from the samples\u003c/h2\u003e \u003cp\u003eResults showed that mother\u0026rsquo;s hands had the highest bacterial contamination of ESKAPE pathogens at 12 (14.5%) with \u003cem\u003eK. pneumoniae\u003c/em\u003e being the most frequent at 8 (24.2%). Baby body and baby catheter tubes had 16 (19.3%) and 12 (14.3%) respectively. \u003cem\u003eS. aureus\u003c/em\u003e was mostly isolated from the baby body (42.9%), and \u003cem\u003eA. baumannii\u003c/em\u003e from the baby tube (25.0%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of ESKAPE Pathogens by Source of Specimen\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSite of Sampling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eESKAPE Pathogens\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eK. pneumoniae\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eA. baumannii\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eE. faecium\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eEnterobacter sp\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaby Body\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16 (19.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBed rail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaby tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen Concentrator\u003c/p\u003e \u003cp\u003eConcentration water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.0%)\u003c/p\u003e \u003cp\u003e2 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFloor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (8.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCup (milk room)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncubator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBench\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAir Sample\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5 (6.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuction Machine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant Warmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3 (3.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTable Top\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (14.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBed underside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAntibiotic Resistance Pattern of ESKAPE Pathogens\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows resistance patterns of Gram-Negative pathogens. The resistance patterns observed indicate that \u003cem\u003eEnterobacter sp\u003c/em\u003e showed high resistance to aztreonam 6/7 (86.7%) and meropenem6/7 (86.7%). \u003cem\u003eK. pneumoniae\u003c/em\u003e exhibited significant resistance to cotrimoxazole 33/33 (100%), cefepime 32/33 (97.0%), aztreonam 30/33 (90.9%) and ceftazidime 31/33 (94.0%). In addition, of the 31 \u003cem\u003eK. pneumoniae\u003c/em\u003e strains tested for ESBL, 15/31 (48.4%) were positive. Importantly, most of the \u003cem\u003eK. pneumoniae\u003c/em\u003e strains were resistant to meropenem. \u003cem\u003eA. baumannii\u003c/em\u003e was highly resistant to aztreonam 24/24 (100%), ceftriaxone 17/24 (70.8%), ceftazidime 22/24 (91.7%), and cefepime 16/24 (66.7%). \u003cem\u003eP. aeruginosa\u003c/em\u003e displayed resistance to aztreonam (66.7%) and meropenem (66.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntimicrobial Resistant Patterns of Gram-Negative ESKAPE Pathogens\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntibiotics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEnterobacter sp (n\u0026thinsp;=\u0026thinsp;7)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eK. pneumoniae (n\u0026thinsp;=\u0026thinsp;33)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eA. baumannii (n\u0026thinsp;=\u0026thinsp;24)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP. aeruginosa (n\u0026thinsp;=\u0026thinsp;3)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eTotal (n\u0026thinsp;=\u0026thinsp;67)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003en (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpicillin/sulbactam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33,3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e41 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAztreonam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (90.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e62 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35 (52.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftazidime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (94.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCotrimoxazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e45 (67.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (97.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15 (22.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (87.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e52 (77.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePiperacillin/Tazobactam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetracycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eNT\u0026thinsp;=\u0026thinsp;ANTIBIOTIC NOT TESTED\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows antibiotic resistance patterns of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eenterococcus sp.\u003c/em\u003e Notably, 5/7 (71.4%) \u003cem\u003eS. aureus\u003c/em\u003e exhibited resistance to cefoxitin, thus classified as methicillin-resistant \u003cem\u003eS. aureus\u003c/em\u003e (MRSA). Expectedly, all five 5/5 (100%) MRSA strains were resistant to penicillin \u003cem\u003eE. faecium\u003c/em\u003e exhibited high resistance to linezolid (88.9%), tetracycline (88.9%), penicillin (77.8%), erythromycin (77.8%), ciprofloxacin (77.8%) and chloramphenicol (77.7%)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntibiotics Resistant Pattern of Gram-Positive ESKAPE Pathogens\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntibiotics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eS. aureus (n\u0026thinsp;=\u0026thinsp;7)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eE. faecium (n\u0026thinsp;=\u0026thinsp;9)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePenicillin G\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCefoxitin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eErythromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChloramphenicol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (77.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNitrofurantoin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLinezolid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVancomycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCotrimoxazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTetracycline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (88.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClindamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (56.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eNT\u0026thinsp;=\u0026thinsp;Antibiotic Not Tested\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the antibiotic susceptibility patterns observed as follows: \u003cem\u003eEnterobacter sp\u003c/em\u003e were highly susceptible to tetracycline (100%), piperacillin/tazobactam (71.4%), and gentamicin (71.4%). \u003cem\u003eK. pneumoniae\u003c/em\u003e demonstrated high susceptibility to amikacin (87.9%) and gentamicin (60.6%). \u003cem\u003eA. baumannii\u003c/em\u003e showed high susceptibility to gentamicin (91.7%) and amikacin (50%). \u003cem\u003eP. aeruginosa\u003c/em\u003e exhibited susceptibility to ampicillin/sulbactam, ciprofloxacin, ceftazidime, and gentamicin (all 66.7%). \u003cem\u003eS. aureus\u003c/em\u003e was highly susceptible to gentamicin (100%), linezolid (85.7%), clindamycin (85.7%), and chloramphenicol (85.7%). \u003cem\u003eE. faecium\u003c/em\u003e showed moderate susceptibility to vancomycin (55.6%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBacterial Contamination and Prevalence of ESKAPE Pathogens\u003c/h2\u003e \u003cp\u003eThe bacterial contamination rate in the NICU was notably high, which indicates a critical issue in the environment from which samples were taken. Studies from various parts of the globe reported similar findings, showing that hospitals often experience high bacterial contamination.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This contamination often arises from bacteria shed by patients, visitors, and healthcare workers, leading to an increased risk of infection among vulnerable patients.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) The current study shows presence of ESKAPE pathogens, particularly on items that are supposed to be sterile, such as milk cups and in oxygen concentration water suggesting that sterilization methods may be insufficient. The presence of ESKAPE on item that are supposed to be sterile could also indicate that the pathogens maybe resistant to the disinfectants being used. Studies have reported bacterial resistance to disinfectants, especially biofilm-producing bacteria like \u003cem\u003eA. baumannii\u003c/em\u003e, which can withstand harsh conditions(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, isolates from the current study were not tested for resistance to disinfectants\u003c/p\u003e \u003cp\u003eThe current study revealed a high prevalence of bacterial contamination in the NICU, with 93.9% of surface swabs showing bacterial growth. Of these, 24.1 were ESKAPE pathogens. The most frequently isolated bacteria were \u003cem\u003eK. pneumoniae\u003c/em\u003e, followed by \u003cem\u003eA. baumannii\u003c/em\u003e, which aligns with a similar study in the NICU of Mpilo Hospital (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In contrast \u003cem\u003eS. aureus\u003c/em\u003e was identified by previous studies as the most common bacteria in their NICU, indicating that different hospital wards may harbor varying bacterial populations. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The isolation of ESKAPE pathogens from NICU surfaces is concerning. Newborn babies are susceptible to infections; thus, their environment should be safe from pathogens. Standard cleaning procedures involve using sterilized gowns and shoes, hand washing with soap, and using disinfected medical equipment. In addition, floors and surfaces should be disinfected frequently and quality checks performed regularly. However, some hospitals in developing countries may not always meet the minimum standards. The current study has revealed that despite the implementation of an Infection Prevention and Control bundle (IPC) in the NICU at UTH, ESKAPE pathogens particularly \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e and \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e are still prevalent (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This persistent contamination highlights the challenges in resource-limited settings, where constraints in space, staffing, and funding hinder the full implementation of traditional IPC measures (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study findings have shown the mother\u0026rsquo;s hands contained the highest number of ESKAPE pathogens (14.5%) of which \u003cem\u003eK. pneumoniae\u003c/em\u003e was the most isolated (66.7%). This is concerning because these mothers are the ones caring for their immunocompromised infants. A previous study to assess hygiene practices of mothers of the NICU at UTH reported that the mothers showed limited consistency in hygiene practices (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The current study suggests a lack of good hygiene practices by the mothers. It could also indicate inadequately prepared hand disinfectants or \u003cem\u003eK. pneumoniae\u003c/em\u003e being resistant to the hand disinfectants provided in the NICU. It is therefore important to note that apart from health care workers, mothers and cleaners are also crucial in driving and sustaining the process to reduce environmental contamination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eAntimicrobial Resistance Patterns of ESKAPE Pathogens\u003c/h2\u003e \u003cp\u003eThe study revealed variable antimicrobial susceptibility patterns among ESKAPE pathogens. Most of the ESKAPE isolates were susceptible to amikacin and gentamicin. These results are similar to previous studies that reported similar results (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Resistance to ampicillin was present in all tested isolates, regardless of species. Based on a previous study it can be speculated that Extended spectrum beta lactamases (ESBLs) are responsible for the observed pattern (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This is supported by the high resistance to third-generation cephalosporins tested in this study.\u003c/p\u003e \u003cp\u003e \u003cem\u003eK. pneumoniae\u003c/em\u003e isolates in this study were positive for phenotypic ESBL. Also, most of the isolates exhibited resistance to the drug class of last resort, meropenem. However, most meropenem-resistant strains though MDR were generally susceptible to gentamicin or amikacin. This is in contrast to a study that reported some resistance to aminoglycosides but complete susceptibility to trimethoprim (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). A previous study in the NICU reported resistance to gentamicin but susceptibility to amikacin and imipenem. (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This observed difference in antibiotic susceptibility patterns despite the results from being obtained from the same NICU could be due to variations in infection control, antibiotic use, sampling periods, or sub clonal populations, reflecting the evolving nature of antimicrobial resistance.\u003c/p\u003e \u003cp\u003e \u003cem\u003eA. baumannii\u003c/em\u003e showed susceptibility to gentamicin and amikacin but resistance to aztreonam and ceftazidime. These results are consistent with a previous study which observed similar trends in \u003cem\u003eA. baumannii\u003c/em\u003e susceptibility patterns. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) .\u003cem\u003eEnterobacter sp\u003c/em\u003e isolates were susceptible to tetracycline, gentamicin, and piperacillin/tazobactam, but resistant to amikacin, aztreonam, and meropenem. This pattern is consistent with previous research on Enterobacter sp (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The findings therefore show the importance of tailored antibiotic therapy in managing infections in the NICU, particularly with drug-resistant pathogens\u003c/p\u003e \u003cp\u003e \u003cem\u003eP. aeruginosa\u003c/em\u003e was less prevalent but exhibited resistance to aztreonam and meropenem, while remaining susceptible to ampicillin/sulbactam, ciprofloxacin, and gentamicin. This is contrast to a previous study that reported \u003cem\u003eP.aeruginosa\u003c/em\u003e to be resistant to ciprofloxacin and another study which reported its susceptibility to piperacillin-tazobactam (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eSimilarly, \u003cem\u003eS. aureus\u003c/em\u003e isolates were highly susceptible to gentamicin and ciprofloxacin but resistant to penicillin and cefoxitin, indicating the presence of MRSA. The detection of cefoxitin resistance is significant because it indicates that these isolates have the \u003cem\u003emecA\u003c/em\u003e gene, which is responsible for altering penicillin-binding proteins and thereby conferring resistance to methicillin and related antibiotics. This agrees with a study that reported that methicillin-resistant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (MRSA) strains are often resistant to beta-lactams but susceptible to non-beta-lactam antibiotics like linezolid and gentamicin (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe antibiotic resistance results for \u003cem\u003eE. faecium\u003c/em\u003e reveal a concerning pattern, with 88.9% of isolates resistant to linezolid and 33.3% resistant to vancomycin. Linezolid is often used as a last-resort antibiotic for treating MDR Gram-positive infections, so high resistance rates severely limit therapeutic options for treating \u003cem\u003eE. faecium\u003c/em\u003e infections. The presence of vancomycin resistance further complicates treatment, as it indicates the potential for the spread of resistance to other critical pathogens such as \u003cem\u003eS. aureus\u003c/em\u003e resulting in Vancomycin-resistance \u003cem\u003eS. aureus\u003c/em\u003e (VRSA)(33)\u003c/p\u003e \u003cp\u003eFinally, the study has reported variability in the susceptibility and resistance of different strains of bacteria to antimicrobial agents. These findings highlight the significance of antibiotic stewardship programs in healthcare settings to optimize antibiotic use and minimize the emergence of resistance. By understanding the resistance patterns of bacterial pathogens, healthcare providers can make informed decisions regarding antibiotic selection, dosage, and duration of therapy, ultimately improving patient outcomes and mitigating the spread of antimicrobial resistance\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS OF THE STUDY\u003c/h2\u003e \u003cp\u003eWe could not ascertain the clonality of the isolated pathogens; therefore, we have not elucidated the spread dynamics of the observed AMR. Whole-genome-based analysis will be necessary to compare sequence types, OH serotypes, plasmid replicons, and AMR genes. Furthermore, whole-genome sequencing will unravel the mechanisms of carbapenem resistance (i.e., plasmid-borne carbapenemase genes or point mutations) and provide insight into the control options.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe study highlights the widespread contamination of NICU environment by ESKAPE pathogens, particularly \u003cem\u003eK. pneumoniae\u003c/em\u003e and \u003cem\u003eA. baumannii\u003c/em\u003e, which were frequently found on mothers\u0026rsquo; hands, baby bodies, and baby tubes. High contamination was also noted on the floor and commonly used equipment like oxygen concentrators. These pathogens exhibited significant resistance to multiple antibiotics which poses challenges for treatment and calls for alternative therapeutic options. \u003cem\u003eP. aeruginosa\u003c/em\u003e showed susceptibility to most antibiotics, although some resistance was observed, warranting continuous resistance surveillance. While \u003cem\u003eS. aureus\u003c/em\u003e showed susceptibility to antibiotics like gentamicin and linezolid, it was MRSA indicating resistance to most beta lactams. \u003cem\u003eE. faecium\u003c/em\u003e demonstrated resistance to several antibiotics but remained susceptible to vancomycin. These findings emphasize the critical need for improved hygiene practices, rigorous infection control, and antimicrobial stewardship to combat the spread of antibiotic-resistant pathogens in the NICU.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCDC : Centre for Disease Control\u003c/p\u003e\n\u003cp\u003eCFU : Colony Forming Units\u003c/p\u003e\n\u003cp\u003eCoNS : Coagulase-negative \u003cem\u003eStaphylococcus\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eESBL : Extended Spectrum Beta-Lactamase\u003c/p\u003e\n\u003cp\u003eGNB : Gram-negative Bacterial\u003c/p\u003e\n\u003cp\u003eHAI : Healthcare-Associated Infections\u003c/p\u003e\n\u003cp\u003eHCW : Healthcare workers\u003c/p\u003e\n\u003cp\u003eICU : Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eLMIC : Low to Middle-income Countries\u003c/p\u003e\n\u003cp\u003eMDR : Multi-Drug Resistance\u003c/p\u003e\n\u003cp\u003eMDRO: Multi-Drug-Resistant Organisms\u003c/p\u003e\n\u003cp\u003eMRSA : Methicillin Resistance \u003cem\u003eS. Aureus\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNI : Nosocomial Infections\u003c/p\u003e\n\u003cp\u003eNICU : Neonatal Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eVRSA : Vacomycin-reistant \u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWHO : World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe author declares that they have no competing interests\u003c/p\u003e\n\u003ch2\u003eCompeting interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was partially funded by the ministry of science and technology\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eSN, as a principal investigator, designed the study, collected and processed the specimens, and drafted the manuscript. AS contributed to the design of the study, data analysis and refined the manuscript. MS, JM and GM contributed to design of the study, formulated the objectives and refined the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eMany thanks to the staff members of the NICU of the WNH as well the mothers who participated in the research. and the Bacteriology Laboratory for all their valuable support. Gratitude goes to the Ministry of Science and technology for the financial support.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003ePlease contact author for data request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli class=\"MsoNormal\"\u003eOgunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - A narrative review. Vol. 9, Antimicrobial Resistance and Infection Control. BioMed Central; 2020.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eRodrigues DO, Peixoto L da P, Barros ETM, Guimaraes JR, Gontijo BC, Almeida JL, et al. Epidemiology of Bacterial Contamination of Inert Hospital Surfaces and Equipment in Critical and Non-critical Care Units: A Brazilian Study. Microbiol Res J Int [Internet]. 2020;31\u0026ndash;43. Available from: https://doi.org/10.1101/793034\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eBara Yusuf J. Bacterial Contamination of Intensive Care Units at a Tertiary Hospital in Bauchi, Northeastern Nigeria. American Journal of Internal Medicine. 2017;5(3):46.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eChristina N, Ioanna P, George L, Konstantinos T, Georgios S. Risk Factors for Nosocomial Infections in Neonatal Intensive Care Units (NICU) [Internet]. Available from: http://imedpub.com\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eMpinda-Joseph P, Anand Paramadhas BD, Reyes G, Maruatona MB, Chise M, Monokwane-Thupiso BB, et al. Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana. Hosp Pract (1995). 2019 Oct 1;47(4):203\u0026ndash;10.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eOgunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - A narrative review. Vol. 9, Antimicrobial Resistance and Infection Control. BioMed Central; 2020.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eWHO Priotiy list 2024.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eBhatta DR, Hosuru Subramanya S, Hamal D, Shrestha R, Gauchan E, Basnet S, et al. Bacterial contamination of neonatal intensive care units: How safe are the neonates? Antimicrob Resist Infect Control. 2021 Dec 1;10(1).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003eBitew K, Gidebo DD, Ali MM. Bacterial contamination rates and drug susceptibility patterns of bacteria recovered from medical equipment, inanimate surfaces, and indoor air of a neonatal intensive care unit and pediatric ward at Hawassa University Comprehensive Specialized Hospital, Ethiopia. IJID Regions. 2021 Dec 1;1:27\u0026ndash;33.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Mbanga J, Sibanda A, Rubayah S, Buwerimwe F, Mambodza K. Multi-Drug Resistant (MDR) Bacterial Isolates on Close Contact Surfaces and Health Care Workers in Intensive Care Units of a Tertiary Hospital in Bulawayo, Zimbabwe. J Adv Med Med Res. 2018 Jul 9;27(2):1\u0026ndash;15.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Shawa M, Paudel A, Chambaro H, Kamboyi H, Nakazwe R, Alutuli L, et al. Trends, patterns and relationship of antimicrobial use and resistance in bacterial isolates tested between 2015\u0026ndash;2020 in a national referral hospital of Zambia. Ahmed MO, editor. PLoS One [Internet]. 2024 Apr 16;19(4):e0302053. Available from: https://dx.plos.org/10.1371/journal.pone.0302053\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Mumbula EM, Kwenda G, Samutela MT. Extended Spectrum \u0026beta;-Lactamases Producing Klebsiella pneumoniae from the Neonatal Intensive Care Unit at the University Teaching Hospital in Lusaka, Zambia. Vol. 4, Jour of Med Sc \u0026amp; Tech. 2015.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e kamfwa 2017.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Park JH, Mwananyanda L, Servidone M, Sichone J, Coffin SE, Hamer DH. Hygiene practices of mothers of hospitalized neonates at a tertiary care neonatal intensive care unit in Zambia. Journal of Water Sanitation and Hygiene for Development. 2019;9(4):662\u0026ndash;70.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Darge A, Kahsay AG, Hailekiros H, Niguse S, Abdulkader M. Bacterial contamination and antimicrobial susceptibility patterns of intensive care units medical equipment and inanimate surfaces at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia. BMC Res Notes. 2019 Sep 23;12(1).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Mbanga J, Sibanda A, Rubayah S, Buwerimwe F, Mambodza K. Multi-Drug Resistant (MDR) Bacterial Isolates on Close Contact Surfaces and Health Care Workers in Intensive Care Units of a Tertiary Hospital in Bulawayo, Zimbabwe. J Adv Med Med Res. 2018 Jul 9;27(2):1\u0026ndash;15.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Mann EE, Manna D, Mettetal MR, May RM, Dannemiller EM, Chung KK, et al. Surface micropattern limits bacterial contamination. Antimicrob Resist Infect Control. 2014 Sep 17;3(1).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e van Dijk HFG, Verbrugh HA, Abee T, Andriessen JW, van Dijk HFG, ter Kuile BH, et al. Resisting disinfectants. Vol. 2, Communications Medicine. Springer Nature; 2022.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Suleyman G, Alangaden G, Bardossy AC. The Role of Environmental Contamination in the Transmission of Nosocomial Pathogens and Healthcare-Associated Infections. Vol. 20, Current Infectious Disease Reports. Current Medicine Group LLC 1; 2018.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Cason C, D\u0026rsquo;accolti M, Campisciano G, Soffritti I, Ponis G, Mazzacane S, et al. Microbial contamination in hospital environment has the potential to colonize preterm newborns\u0026rsquo; nasal cavities. Pathogens. 2021 May 1;10(5).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Park JH, Mwananyanda L, Servidone M, Sichone J, Coffin SE, Hamer DH. Hygiene practices of mothers of hospitalized neonates at a tertiary care neonatal intensive care unit in Zambia. Journal of Water Sanitation and Hygiene for Development. 2019;9(4):662\u0026ndash;70.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Khasapane NG, Nkhebenyane SJ, Lekota K, Thekisoe O, Ramatla T. \u0026ldquo; One Health \u0026rdquo; Perspective on Prevalence of ESKAPE Pathogens in Africa : A Systematic Review and Meta-Analysis. 2024;\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Halim MMA, Eyada IK, Tongun RM. Prevalence of multidrug drug resistant organisms and hand hygiene compliance in surgical NICU in Cairo University Specialized Pediatric Hospital. Egyptian Pediatric Association Gazette [Internet]. 2018;66(4):103\u0026ndash;11. Available from: https://doi.org/10.1016/j.epag.2018.09.003\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Bhatta DR, Hosuru Subramanya S, Hamal D, Shrestha R, Gauchan E, Basnet S, et al. Bacterial contamination of neonatal intensive care units: How safe are the neonates? Antimicrob Resist Infect Control. 2021 Dec 1;10(1).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Shawa M, Paudel A, Chambaro H, Kamboyi H, Nakazwe R, Alutuli L, et al. Trends, patterns and relationship of antimicrobial use and resistance in bacterial isolates tested between 2015\u0026ndash;2020 in a national referral hospital of Zambia. PLoS One. 2024 Apr 1;19(4 April).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Bereanu AS, Bereanu R, Mohor C, Vintilă BI, Codru IR, Olteanu C, et al. Prevalence of Infections and Antimicrobial Resistance of ESKAPE Group Bacteria Isolated from Patients Admitted to the Intensive Care Unit of a County Emergency Hospital in Romania. Antibiotics. 2024;13(5).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Mumbula EM, Kwenda G, Samutela MT. Extended Spectrum \u0026beta;-Lactamases Producing Klebsiella pneumoniae from the Neonatal Intensive Care Unit at the University Teaching Hospital in Lusaka, Zambia. Vol. 4, Jour of Med Sc \u0026amp; Tech. 2015.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Nair V, Sahni AK, Sharma D, Grover N, Shankar S, Chakravarty A, et al. Point prevalence \u0026amp; risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India. Indian Journal of Medical Research. 2017 Jun 1;145(June):824\u0026ndash;32.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Cata\u0026ntilde;o JC, Echeverri LM, Szela C. Bacterial contamination of clothes and environmental items in a third-level hospital in Colombia. Interdiscip Perspect Infect Dis. 2012;2012.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Pandey R, Mishra SK, Shrestha A. Characterisation of eskape pathogens with special reference to multidrug resistance and biofilm production in a nepalese hospital. Infect Drug Resist. 2021;14:2201\u0026ndash;12.\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Azimi L, Fallah F, Karimi A, Shirvani F, Tehrani NA, Armin S, et al. Prevalence and Antimicrobial Resistance Patterns in ESKAPE Pathogens in Iran. Arch Pediatr Infect Dis. 2023;11(1).\u003c/li\u003e\n \u003cli class=\"MsoNormal\"\u003e Navidinia M, Goudarzi M, Rameshe SM, Farajollahi Z, Asl PE, Khosravi SZ, et al. Molecular characterization of resistance genes in MDR-ESKAPE pathogens. J Pure Appl Microbiol. 2017 Jun 1;11(2):779\u0026ndash;92.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, ESKAPE Pathogens, Antibiotic Resistance and Neonatal Intensive Care Unit","lastPublishedDoi":"10.21203/rs.3.rs-5327822/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5327822/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The hospital environment serves as a significant reservoir of microorganisms, including multidrug-resistant (MDR) pathogens, which can lead to in-patient contamination and healthcare-associated infections (HAIs). MDR bacteria are predominantly found in Neonatal Intensive Care Unit (NICU) due to the frequent use of invasive medical devices, the variety of medical procedures performed, and the prolonged antibiotic treatments required by critically ill neonates. These factors, along with extended hospital stays, create an environment that fosters the development of MDR infections. Key pathogens involved in NICU-acquired infections such as \u003cem\u003eE. faecium, S. aureus\u003c/em\u003e, \u003cem\u003eK. pneumoniae\u003c/em\u003e, \u003cem\u003eA. baumannii\u003c/em\u003e, \u003cem\u003eP. aeruginosa\u003c/em\u003e, and \u003cem\u003eEnterobacter sp\u003c/em\u003e., are collectively known as ESKAPE pathogens. They are known for their antibiotic resistance, posing challenges for treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a cross-sectional study conducted from April 2023 to April 2024. The study aimed at investigating the contamination and antibiotic resistance profiles in the NICU at the Women and Newborn Hospital. A total of 344 Samples were collected from different inanimate objects including baby bodies, baby tubes, and mother's hands using sterile moistened swabs. Bacterial isolates were identified using standard microbiological procedures and antimicrobial susceptibility testing was performed using the Kirby-Bauer method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: bacterial contamination rate was (93.9%), with 25.7% of samples containing ESKAPE pathogens. \u003cem\u003eK. pneumoniae\u003c/em\u003e was the most prevalent bacteria with the most isolates found on mother’s hands. Antimicrobial susceptibility varied among ESKAPE pathogens with a total of 75 (90%) of the 83 ESKAPE isolates MDR. Gram-negative pathogens were highly susceptible to gentamicin and amikacin but showed significant resistance to\u003c/p\u003e\n\u003cp\u003eaztreonam, piperacillin tazobactam, and meropenem. Gram-positive pathogens were susceptible to gentamicin, linezolid, vancomycin, and clindamycin, but resistant to penicillin, cefotaxime, and erythromycin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: There was a high bacterial contamination and MDR ESKAPE pathogens in the NICU. Given that most of the isolates were susceptible to gentamicin and amikacin, there should be continued monitoring and judicious use of gentamicin and amikacin to curb antibiotic resistance development.\u003c/p\u003e","manuscriptTitle":"Prevalence and Antibiotic Resistance Profile of ESKAPE Pathogens in the Neonatal Intensive Care Unit of the Women and Newborn Hospital in Lusaka, Zambia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 14:15:42","doi":"10.21203/rs.3.rs-5327822/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-10T09:58:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-10T00:29:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-14T14:32:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295999553274098395165272360582903108430","date":"2024-12-06T06:31:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225215125047394482977057687374746762238","date":"2024-11-29T05:34:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-26T19:38:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-29T06:03:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-29T06:03:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Antimicrobial Resistance \u0026 Infection Control","date":"2024-10-24T18:05:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"antimicrobial-resistance-and-infection-control","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aric","sideBox":"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)","snPcode":"13756","submissionUrl":"https://submission.nature.com/new-submission/13756/3","title":"Antimicrobial Resistance \u0026 Infection Control","twitterHandle":"@ARICJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ef0c58a-a987-43b6-88d2-4bbe323f4438","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-11T16:02:06+00:00","versionOfRecord":{"articleIdentity":"rs-5327822","link":"https://doi.org/10.1186/s13756-025-01588-5","journal":{"identity":"antimicrobial-resistance-and-infection-control","isVorOnly":false,"title":"Antimicrobial Resistance \u0026 Infection Control"},"publishedOn":"2025-08-05 15:57:36","publishedOnDateReadable":"August 5th, 2025"},"versionCreatedAt":"2024-11-19 14:15:42","video":"","vorDoi":"10.1186/s13756-025-01588-5","vorDoiUrl":"https://doi.org/10.1186/s13756-025-01588-5","workflowStages":[]},"version":"v1","identity":"rs-5327822","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5327822","identity":"rs-5327822","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}