Temporal Trends and Antimicrobial Susceptibility Patterns of ESKAPE Pathogens Recovered from Clinical Specimens in Western Oromia, Ethiopia: Implications for AMR Surveillance and Antimicrobial Stewardship

Background: ESKAPE pathogens are the leading causes of healthcare-associated and community-acquired infections worldwide. Despite this, there is limited evidence on temporal trends and antimicrobial susceptibility patterns of these pathogens in Western Oromia, Ethiopia. This study assessed temporal trends and antimicrobial susceptibility patterns of ESKAPE pathogens recovered from clinical specimens. Methods: Microbiology records from 2023–2025 were analyzed to characterize the antimicrobial susceptibility patterns and temporal trends of ESKAPE pathogens. The pathogens were identified using standard microbiological methods, and AST was performed using the Kirby–Bauer disk diffusion method. Data were entered into EpiData version 4.6 and analyzed using SPSS version 27. Descriptive statistics, chi-square tests, and the Cochran–Armitage trend test were used to assess distributions and temporal changes in ESKAPE pathogens. Statistical significance was determined at p < 0.05. Results: Of the total 954 bacteria isolated, ESKAPE pathogens accounted for 568 (59.5%) with S. aureus (354; 62.3%) and K. pneumoniae (94; 16.5%) being predominant. ESKAPE prevalence increased from 56.5% in 2023 to 65.0% in 2024, then declined to 57.1% in 2025. The distribution of ESKAPE and non-ESKAPE pathogens did not differ significantly across the three study years ( p =0.056). Antimicrobial susceptibility testing revealed that S. aureus isolates showed an alarming resistance of 95 – 99.0% to penicillin over the three years. K. pneumoniae indicated 79.4% resistance to third-generation cephalosporins (ceftriaxone and ceftazidime) in 2025. In addition, high resistance of 76.5% was observed against cefepime, a fourth-generation cephalosporin. Moreover, Pseudomonas isolates demonstrated increased resistance rates to meropenem from 2023 through 2025 accounting for 50.0%, 57.1%, and 71.1%, respectively. Among the ESKAPE isolates, 351 (61.8%) were multidrug-resistant (MDR), predominantly S. aureus (243; 69.2%) and K. pneumoniae (71; 20.2%). Conclusion: The consistently high and variable occurrence of ESKAPE pathogens, rising antimicrobial resistance, and the burden of MDR organisms highlight the pressing necessity to enhance antimicrobial stewardship and infection prevention and control (IPC) strategies. Continuous AMR monitoring, data-driven antibiotic utilization, and successful IPC measures are crucial to reduce the rise and spread of resistant ESKAPE organisms.