What are ESKAPE pathogens

MDR (multi-drug resistance pathogens) are a global problem and hospital wide resistance pathogens is a growing concern and there is a greater risk for nosocomial infection by such pathogens so what are ESKAPE pathogens?

E : Enterococcus Faecium

It is a gram positive bacteria, related to genus Enterococcus. VRE is the Vancomycin Resistance Enterococcus and treated with either Linezolid or Daptomycin.

S : Staphylococcus aureus

Gram Positive bacteria usually found in the nose and the skin of healthy people. Methicilline resistance from of staph aureus or known as MRSA is increasing and it is one of hard to treat infections. Linezolid and vancomycin are used to treat MRSA.

K : Klebsiella pneumoniae

Gram negative bacteria, the ESBL “Extended spectrum B- Lactamases” producing K. pneumoniae is very common and and recently due to the overuse or abuse of carbapenems, KPC “K. Pneumoniae carbapenemases” is very common and it is a serious infection that usually a combination of antimicrobial is used to fight such infection. New drugs like Avycaz might have activity against carabapenemases.

A : Acinetobacter baumannii

It is an aerobic gram-negative bacterium, A baumannii is inherently resistant to multiple antibiotics so that it is one of the most difficult to treat infections and usually colisitin is involved in treating such infection in combination with other antibiotics.

P : Pseudomonas aeruginosa

Gram negative bacteria, nosocomial infection with Pseudomonas aeruginosa is a nightmare for health care professional.  For critically ill patients like patients in the ICU, MDR Pseudomonas aeruginosa is a killing infection due to the resistance to most antibiotics even the newer antibiotics.

E : Enterobacter species

Enterobacter is a genus of Gram-negative bacteria that most commonly infects the urinary and respiratory tracts. These species are typically resistant to multiple generations of Penicillins and Cephalosporins. Several strains of such group are causing opportunistic infections usually in immune-compromised patients.

E. aerogenes and E. cloacae are the most common species, usually you will find one of them in microbiology report of sterile body fluid of hospitalized patient and yet I have seen E. aerogenes that are intermediate resistance or resistance to piptazo “Tazocin” and sometimes resistance to carbapenems like imipenem.


So, The ESKAPE pathogens are the leading cause of nosocomial infections in healthcare settings. Usually they are multi-drug resistant isolates, which is one of the greatest challenges in clinical practice.However, recently the definition has changed in some papers to replace “K” with “C” to be ESCAPE!

The C stands for Clostridium difficile due to the growing virulence of C. difficile. Reference for the change: Here


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