## 3 Results
### Clinical Origin of Gram-Negative ESKAPE Bacteria  
A total of 7343 samples were collected from different sources. Most of them were isolated from pus (1775, 24.17%), blood (1521, 20.71%), endotracheal (1272, 17.32%), urine (1200, 16.34%), sputum (562 samples, 7.65%), wound swab (322 samples, 4.39%), and bile (246 samples, 3.35%). Less frequently encountered specimen types included tissue (102 samples, 1.39%), bronchoalveolar lavage (BAL) fluid (99 samples, 1.34%), and tracheal aspirate (64 samples, 0.87%). Specimens such as cerebrospinal fluid (CSF) (44 samples, 0.60%), aspirated fluid (33 samples, 0.44%), pleural fluid (20 samples, 0.27%), and drain fluid (18 samples, 0.24%) were also represented. Rare specimen types consist of oral swab and pigtail drain fluid, with 10 samples each (0.14%), peritoneal fluid (9 samples, 0.12%),  
Figure 1: Gram-negative ESKAPE pathogens isolated from IMS and SUM Hospital.  
stool (8 samples, 0.11%), and both CBD stent and throat swab with 7 samples each (0.10%). The least represented specimen was asciti fluid, contributing only 5 samples (0.07%) (Figure 2).  
Among the sample _K. pneumoniae_ isolates (_n_ = 4112), the majority were obtained from blood (22.6%), pus (21.6%), and urine (19.8%), indicating their predominance in bloodstream, wound, and urinary tract infections. Respiratory samples, such as ET aspirates (15.7%) and sputum (7.4%), also contributed significantly. Lower proportions were recovered from bile, wound swabs, BAL fluid, and sterile sites like CSF and peritoneal fluid. This highlights the organism's broad clinical spectrum and its role in both invasive and localized infections. The majority of the _P. aeruginosa_ isolates (_n_ = 1295) were recovered from pus (32.4%) and urine (18.2%), indicating a strong association with wound and urinary tract infections. Respiratory specimens, such as sputum (11.4%), ET aspirates (7.6%), and tracheal aspirates (4.9%), also showed notable representation. Blood samples contributed 10.8%, highlighting their invasive potential. Isolates from CSF, pleural, asciti, and bile fluids were relatively scarce. Among the _A. baumannii_ complex isolates (_n_ = 1285), the majority were obtained from endotracheal (ET) aspirates (36.03%), followed by pus (21.55%) and blood (21.55%), reflecting its predominance in ventilator-associated and invasive infections. Spu-tum (6.69%) and wound swabs (5.75%) also exhibit key contributions. Isolates from urine, tissue, BAL fluid, and CSF were comparatively less frequent. Among the _A. baumannii_ isolates (_n_ = 217), the highest proportion was recovered from blood (44.2%), highlighting its major role in bloodstream infections. This was followed by endotracheal (ET) aspirates (27.6%) and pus (12.9%), sputum (7.8%), and wound swabs (7.4%). For _E. cloacae_ complex isolates (_n_ = 430), the majority were recovered from pus (37.7%), followed by urine (18.6%) and blood (17.7%), indicating its involvement in wound, urinary tract, and bloodstream infections. Wound swabs (9.5%) and tissue samples (4.19%) also contributed notably. Less common sources included bile, sputum, bronchoalveolar lavage fluid, stool, CSF, and ET aspirates, each accounting for under 4%, reflecting the pathogen's presence across a wide  
Figure 2: Percentage distribution of various clinical isolates in different departments.  
range of clinical specimens. Regarding _E. cloacae_ isolates (\(n=4\)), half were recovered from blood samples (50%), indicating potential for invasive infections. The remaining isolates were evenly split between bile and pus (25% each), suggesting occasional involvement in hepatobiliary and wound infections. Though the sample size is small, the distribution points to a capacity for both localized and systemic infections (Figure S1).