Antimicrobial Resistance of ESKAPE Pathogens Identified in Patients with Necrotizing Fasciitis: A 10-Year Retrospective Study.

Background and

Objectives

ESKAPE pathogens-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.-are major contributors to antimicrobial resistance and are associated with considerable morbidity and mortality. Their involvement in community-acquired necrotizing fasciitis (CA-NF) remains insufficiently characterized. This study aimed to determine whether ESKAPE pathogens are implicated in cases of CA-NF and to describe their prevalence, antimicrobial resistance profiles, and associated clinical outcomes. Materials and

Methods

We conducted a retrospective single-center study of NF cases treated in the Plastic Surgery Department of the Emergency Hospital Bucharest (2012-2022). Sixty-five patients met clinical and surgical diagnostic criteria; cases without microbiological data were excluded. Of these, 21 patients had ESKAPE pathogens isolated within 60 min of admission and formed the study cohort. Demographic, clinical, laboratory, microbiological, susceptibility, treatment, and outcome data were analyzed descriptively, with a focus on associated mortality with exploratory comparisons to ESKAPE-negative cases.

Results

ESKAPE pathogens were identified in 31.8% (21/65) of patients. S. aureus was most common (61.9%); 14.3% were MRSA (Methicillin resistant Staphylococcus aureus) and 47.6% MSSA (Methicillin sensitive Staphylococcus aureus). Overall, 52% of ESKAPE isolates were multidrug-resistant and 12% were extensively drug-resistant. These resistance patterns have implications for empiric therapy in community-acquired NF.

Conclusions

ESKAPE pathogens accounted for a substantial proportion of CA-NF and frequently displayed multidrug resistance. These findings highlight the importance of considering ESKAPE pathogens in empiric management strategies for NF, particularly within regional clinical practice.