Antimicrobial resistance trends of ESKAPEE pathogens isolated from intensive care unit patients at a tertiary care hospital in Mogadishu, Somalia: a retrospective study (2020–2024)

Abstract

Background The ESKAPEE pathogens Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , Enterobacter spp. and Escherichia coli are the leading causes of nosocomial infections and are notorious for their multidrug resistance (MDR). Data on their prevalence and resistance patterns in Somalia remain scarce. This study aims to delineate the epidemiology and antimicrobial resistance profiles of ESKAPEE isolates from the intensive care unit (ICU) patients over 5 years at Somali Turkish Recep Tayyip Erdogan Hospital, Mogadishu. Methods A retrospective review was conducted based on microbiological data from ICU patients admitted between January 2020 and October 2024. Clinical specimens were processed using standard microbiological techniques, and isolates were identified via biochemical assays. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method in accordance with CLSI guidelines. MDR was defined as resistance to three or more antimicrobial classes. Data were analyzed using R software v4.1.2. Results A total of 1,632 ESKAPEE isolates were obtained from 1,632 clinical specimens. E. coli was the most common pathogen (42.16%), followed by S. aureus (17.77%), P. aeruginosa (17.65%), and A. baumannii (11.89%). The rate of MDR was higher in A . baumannii (85%) and K . pneumoniae (78%). Notably, carbapenem resistance was present in 70% of A . baumannii and 55% of K . pneumoniae isolates. There was low resistance to vancomycin among S. aureus isolates resistance reached approximately 6% in 2024; overall susceptibility remained 94%. Resistance to vancomycin was found in 12.5% of E. faecium isolates. Methicillin-resistant S. aureus (MRSA) increased sharply to a peak of 78.8% in 2023 before declining in 2024, highlighting unstable but concerning resistance dynamics. MDR patterns differed across pathogens, with multi-drug resistance most common among Gram-negative species. Conclusion The high prevalence of MDR ESKAPEE pathogens, particularly carbapenem-resistant A . baumannii and K . pneumoniae , underscores the urgent need for robust antimicrobial stewardship and infection control strategies in Somali ICUs. Continuous surveillance and tailored empiric therapy protocols are critical to combating the mounting AMR threat in resource-limited settings.