## 3 Results
### Antibiotic Resistance and Susceptibility Profiling in Gram-Negative Isolates  
Antibiotic resistance patterns play a major role in ESKAPE pathogens, unveiling a concerning landscape of dwindling therapeutic options. _K. pneumoniae_ exhibits complete resistance to Ampicillin and near-total resistance to Ticarcillin (99.76%), Ampicillin/Sulbactam (96.08%), and Aztrenoam (88.36%). Fosfomycin (76.47%) and Tigecycline (75.96%) remained the most effective, positioning them as critical last-line therapies. High intermediate susceptibility to Colistin (91.10%), Polymycin B (88.07%), and Nitrofurantoin (37.23%) adds complexity to treatment choice (Figure S8). However, the year-wise resistance profile of _K. pneumoniae_ revealed a significant reduction in resistance for Ceftazidime, Gentamicin, Imipenem, and Tigecycline (_p_ < 0.05), suggesting improved therapeutic outcomes or evolving treatment practices (Table S1). _P. aeruginosa_ exhibited complete resistance to Chloramphenicol and near-complete resistance to Tigecycline (99.56%). However, Ofloxacin (80%), Imipenem (56.36%), and Meropenem (52.99%) showed greater efficacy. Notably high intermediate rates for Polymyxin B (92.31%) and Colistin (91.51%) signal unpredictable treatment outcomes (Figure S9). The year-wise resistance profile indicates a significant decline in the resistance of _P. aeruginosa_ for multiple antibiotics, including Amikacin (from 39.65% to 31.1%, \(p\) = 0.0038), Levofloxacin, Ciprofloxacin, Cefepime, Ceftazidime, Meropenem, and Imipenem (_p_ < 0.05) (Table S1). The _A. baumannii_ complex demonstrated broad resistance, with rates often surpassing 85% for drugs like Chloramphenicol, Tobramycin, Piperacillin/Tazobactam, Meropenem, and Imipenem. Susceptibility was limited to Minocycline (37.88%), Trimethoprim/Sulfamethoxazole (28.22%), and Gentamicin (21.77%), while Colistin (up to 96.21%) and Polymyxin B (94.22%) showed consistently high intermediate responses, complicating reliable therapy selection (Figure S10). Similarly, isolates of _A. baumannii_ showed resistance to Chloramphenicol, Tobramycin, Meropenem, and Ceftazidime (Figure S11). The year-wise analysis of the resistance profile of the _A. baumannii_ complex revealed a significant reduction in resistance to Ceftazidime (_p_ = 0.0026), Netilmicin (_p_ = 0.0073), Doxycycline (_p_ = 0.0243), and Levofloxacin (_p_ = 0.0305), yet it continued to exhibit high resistance levels, especially with Colistin and Polymyxin B (Table S1). The _E. cloace_ complex presented a high resistance to Amoxicillin/Clavulanic Acid, Cefalotin, Cefoxitin, and several cephalosporins, but strong susceptibility to Tigecycline (93.68%), Minocycline (83.84%), Norfloxacin (90.70%), and Amikacin (76.92%), Colistin (89.12%) and Nitrofurantoin (46.51%) had the highest intermediate rates (Figure S12). Whereas _E. cloace_ showed complete resistance to multiple beta-lactams and carbapenemems, yet full susceptibility to Chloramphenicol, Doxycycline, and Levofloxacin. However, intermediate susceptibility to Colistin, Ceftriaxone, and Minocycline underscores the need for cautious treatment optimization (Figure S13). For the _E. cloace_ complex, significant year-wise decreases in resistance to Minocycline (_p_ = 0.0184) and Tigecycline (_p_ = 0.0343) were observed, although its resistance to carbapenemems and \(\beta\)-lactam/\(\beta\)-lactamase inhibitor combinations remained high or appeared to increase, with limited data precluding comprehensive statistical evaluation (Table S1).