## 1 Introduction  
The widespread misuse and overuse of antibiotics result in the emergence of antimicrobial resistance (AMR) and multidrug-resistant (MDR) bacteria, which lead to a public health crisis [1]. According to statistical reports of 2019, 1.27 million deaths were caused by antibiotic resistance of bacteria, and 4.95 million deaths were directly associated with bacterial resistance [2, 3]. The World Health Organization (WHO) projects that by 2050, AMR could lead to as many as 10 million deaths annually, surpassing mortality from cancer and other major diseases [4]. According to the Centers for Disease Control and Prevention (CDC), about 23,000 deaths per year in the United States of America (USA) are due to antibiotic-resistant microorganisms [5]. In February 2017, the World Health Organization(WHO) released a global priority list of antibiotic-resistant pathogens for which the development of new antimicrobial therapies is deemed critical. Notably, this list includes several members of the ESKAPE group--_Enterococcus faecium_, _Staphylococcus aureus_, _Klebsiella pneumoniae_, _Acinetobacter humannii_, _Pseudomonas aeruginosa_, and _Enterobacter_ spp.--due to their higher rate of resistance emergence and association with life-threatening nosocomial infections [6]. This group of bacteria is of critical importance due to their natural and widespread resistance to antibiotics, along with their ability to acquire numerous resistance genes that render them multidrug-resistant [7]. Moreover, they are recognized as life-threatening pathogens behind healthcare-associated infections (HAIs), particularly in critically ill and immunocompromised individuals [5; 7]. Several studies have shown that patients with AMR infection have more difficulty receiving suitable treatment, which worsens the situation [8; 9]. Although India is recognized as a hotspot for antibiotic resistance, data on AMR-related deaths in India are limited due to inadequate surveillance studies. The Indian Council of Medical Research (ICMR) highlights alarming resistance trends in the case of Gram-negative _K. pneumoniae_, _A. baumannii_, and _P. aeruginosa_, which dominate the clinical samples and limit treatment options. The National Action Plan on AMR (2017) promotes surveillance, but widespread antibiotic misuse and environmental contamination demand urgent stewardship and infection control to curb the escalating threats of AMR [10; 11]. In Odisha, especially in rural and tribal areas, AMR poses a significant challenge due to limited access to healthcare facilities and community awareness regarding the use of antibiotics. Odisha contributes to the National AMR Surveillance Network, with state medical colleges monitoring resistance trends, but inadequate infrastructure and socioeconomic barriers hinder progress. Very few initiatives like the SOBEAR study have been initiated to combat the impact of AMR in the state [12]. Gram-negative bacteria are more virulent than Gram-positive bacteria due to their outer membrane, which contains lipopolysaccharide (LPS) that acts as a potential endotoxin and triggers a severe immune response [13]. Their outer membrane serves as a barrier that enhances antibiotic resistance and host defenses, while the secretion of endotoxin directly into the host cells adds to the severity [14; 15]. Furthermore, they can form biofilms that further increase their pathogenicity [16]. These factors collectively make Gram-negative bacteria more predominant in health care settings. In line with this trend, surveillance data from hospitals indicate that Gram-negative pathogens are key contributors to HAIs within nosocomial settings. _K. pneumoniae_ is a non-motile, opportunistic pathogen with a remarkable capacity to acquire antimicrobial resistance, primarily through the horizontal transfer of mobile genetic elements carrying resistance genes.