## 4 Discussion  
In recent decades, nosocomial infections have posed a serious threat to the health care system worldwide, more pronouncedly in developing countries [27]. Multiple bacterial species can be the root cause of various infectious diseases in tertiary care centers. Among these, the ESKAPE group of pathogens has emerged as predominant due to their strong association with antibiotic resistance. To effectively reduce their prevalence, localized surveillance within individual healthcare settings is necessary to develop a tailored hospital-specific empirical treatment therapy [28; 29; 30]. The organisms frequently recovered from our University hospital were members of the ESKAPE group, with a predominance of Gram-negative bacteria. The most frequently encountered Gram-negative pathogens include _K. pneumoniae_, _P. aeruginosa_, and _A. baumannii_, which correlates with previous studies [31; 32]. _K. pneumoniae_ was primarily isolated from blood, pus, and urine, underscoring its crucial role in bloodstream, wound, and urinary tract infections [33; 34]. _P. aeruginosa_ was mainly recovered from pus and urine, highlighting its strong association with wound and urinary tract infections, as reported in previous hospital-acquired infection studies [35]. The _A. baumannii_ complex exhibited the highest proportion in endotracheal aspirates, indicating its widely spread incidence in ventilator-associated infections, a common finding in intensive care units [36]. _A. baumanniii_ isolates were predominantly from blood, emphasizing their critical role in bloodstream infections, aligning with reports on their invasive potential [37]. _E. cloacae_ complex and _E. cloacae_ isolates were mainly associated with pus and blood, respectively, pointing to their involvement in wound infections [38]. In our present study, _K. pneumoniae_ was found to be more prevalent in male patients compared to female patients. The previous study also reported similar findings, where the majority of _K. pneumoniae_ isolates were obtained from male patients [39; 40]. A similar male dominance in the infection rates was observed for _P. aeruginosa_, _A. baumannii_, _E. cloacae_ complex, and _A. baumannii_ complex [41; 42; 43; 44]. _K. pneumoniae_ was mainly associated with wards and ICUs, indicating its link in both community and hospital-acquired infections [45]. Whereas, _P. aeruginosa_ was commonly found in wards and outpatient departments, reflecting its environmental resilience and opportunistic nature in high-traffic, less critical areas [35; 46]. The _A. baumannii_ complex, along with _A. baumannii_, known for severe drug resistance, was predominantly found in ICUs and critical care medicine units [47]. The _E. cloacae_ complex is mainly associated with non-critical areas that including wards and the outdoor department, suggesting its clinical significance that might be underrecognized. The seasonal distribution pattern of bacterial isolates highlights recognizable seasonal patterns. _K. pneumoniae_ and _P. aeruginosa_ exhibited high occurrence during the monsoon, perhaps due to environmental factors like elevated temperature and humidity, which exhibit variation with previous studies, where a surge in infection rate is observed during warmer months [48; 49]. On the other hand, _A. baumannii_ and the _E. cloacae_ complex showed relatively stable distributions [50; 51]. _A. baumannii_ also shows a sharp monsoon peak, potentially linked to environmental persistence in humid conditions [52], whereas the _E. cloacae_ complex displays a more variable pattern, possibly due to its opportunistic nature and lower-case numbers [51]. The present study highlights the significant burden of Gram-negative bacterial infections, particularly among adults aged 18 to 64 years. _K. pneumoniae_ exhibited the highest infection rate, with notable antimicrobial resistance, particularly within the 18-49 age group [53]. _P. aeruginosa_ also showed elevated resistance in the 18-49 age group, complicating treatment options [54]. In our study, the _A.