## 4 Discussion
baumannii_ complex and _A. baumannii_ demonstrated a high resistance to multiple antibiotics, mostly affecting the 18-49 age group. This marks a notable epidemiological shift, diverging from established trends in the literature, which states that infection with _A. baumannii_, especially its MDR variants, is associated with elderly and immunocompromised populations [55]. The _E. cloacae_ complex displayed significant resistance in the 18-49 age group, while the limited cases of _E. cloacae_ prevented robust resistance analysis. Notably, our study reveals that the majority of infected individuals were within the age group of 18-64 years, particularly within the 18-49 age group, which diverges from the traditional assumption that AMR primarily affects the elderly and immunocompromised individuals [56; 57]. The antibiotic resistance pattern of _K. pneumoniae_ isolates reveals a dire scenario, with complete resistance to Ampicillin and near-complete resistance to Ampicillin/Sulbactam, which correlates with the previous studies in Saudi Arabia and India [58; 59]. In contrast, Fosfomycin and Tigecycline exhibit effectiveness against these strains, serving as critical last-resort options for extensively drug-resistant strains [60; 61]. Another ESKAPE pathogen, _P. aeruginosa_, reveals extreme resistance to Chloramphenicol and Tigecycline in our findings, while exhibiting higher susceptibility to Ofloxacin, Amikacin, Imipenem, and Meropenem, which coincides with previous surveillance study findings [62]. These findings, coupled with the susceptibility/resistance profiles of antibiotics, underscore the urgent need for novel therapies and robust antimicrobial stewardship to preserve effective agents. According to the current study, the _A. baumannii_ complex and _A. baumannii_ exhibit multidrugresistance to a broad spectrum of antibiotics, with the highest resistance to Chloramphenicol and relatively higher resistance to Meropenem as well as Tobramycin [63], which tally with the findings in the previous studies, whereas last resort antibiotics like Colistin exhibit extensive intermediate susceptibility, suggesting potential use in combination therapies [64]. Compared to other MDR pathogens, _A. baumanniii_'s resistance is more pervasive, often necessitating last-resort agents or novel strategies [65]. The _E. cloacae_ complex demonstrates a versatile antibiotic resistance profile, with significant resistance to multiple antibiotics, including near-complete resistance to Amoxicillin/Clavulanic Acid, Cefalotin, and Cefoxitin. This resistance pattern aligns with previous findings in similar studies. In contrast, high susceptibility was observed for Tigecycline and Norfloxacin, indicating these antibiotics as potentially effective therapeutic options, consistent with previous studies [66]. The _E. cloacae_ isolate exhibited complete resistance to Amoxicillin/Clavulanic Acid, Cefuroxime, Cefuroxime Axetil, Imipenem, Cefoxitin, and Piperacillin/Tazobactam, showing comprehensive resistance to \(\beta\)-lactams and Cephalosporin group of antibiotics [67; 68]. Conversely, they showed complete susceptibility to Cefiazidime/Avibactam, Cefiazoxime, which contrasts with previous studies conducted by [PERSON] and coauthors, where they have reported higher resistance to cephalospor, suggesting their potential as effective therapeutic options [69]. This variability emphasizes the importance of ongoing surveillance and personalized treatment strategies to combat the evolving resistance patterns of _E. cloacae._  
The resistance trends among Gram-negative pathogens _K. pneumoniae, P. aeruginosa, A. buumannii_ complex, and _E. cloacae_ complex from 2023 to 2024 reveal a dual narrative of progress and persistent challenges in tackling multidrug resistance. Significant reductions in resistance to antibiotics such as ceftazidime, gentamicin, imipenem, and tigecycline in _K.