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Introduction
Directive Publications Ekeleme Jessica Ezinne released its first edition of the 12 bacterial drug-pathogen priority list – a list of drug-pathogen combination bacteria that pose the greatest threat to human health because of the emergence of multidrug resistance, (WHO,2023). ESKAPE pathogens have adapted and developed resistance to antibiotics via the development of different mechanistic approaches. Most common include the development of drug-inactivating mechanisms such as β-lactamases and aminoglycoside-modifying enzymes (Oliveira et al., 2020). Likewise, modification of the target site, development of efflux pumps, and biofilm production have been effective armors against different antibiotics (Ramirez and Tolmasky, 2010). Importantly, the development of resistance by genetic mutations, mobile genetic element (MGE) acquisition, and their horizontal transfer among the circulating population has been inevitable (Patridge et al, 2018). Most strains circulating in the healthcare setting have developed the ability to produce biofilms, as a tool for adherence to indwelling medical equipment, therefore elevating the incidence of nosocomial infections (Asefa and Amare, 2022). It is indeed concerning from the findings of multiple studies on ESKAPE pathogens that they have not only represented a substantial proportion of the causation of all infections but have also been associated with increased length of hospital stay and a substantial spike in healthcare cost to the individual and nation as a whole (Tzouvelekis et al.,2012; Ranjit et al., 2025). In a city like Aba , in the heart of south eastern Nigeria, there are many hospitals with limited regulatory activities on issues of AMR and nosocomial infections, some hospitals do not have enough room spaces and end up crowding the environments making the spread of AMRs easier. More so, most hospitals use non- qualified individuals for the role of cleaning demeaning its importance in combating the rise in Antimicrobial resistance, this necessitated this study. The aim of this study therefore is to isolate, identify, and assess the antibiotic susceptibility patterns of bacteria found on frequently used fomites in the two popular hospitals in Aba Abia State. METHODOLOGY Collection of samples Samples were collected from two different hospitals in Aba, a government owned hospital and a private hospital. The Five wards used in the study were the children’s ward, male wards, female wards, Injection rooms and emergency rooms. With the use of sterile swabs sticks moistened in sterile normal saline, inanimate surfaces which were frequently touched were selected for the sampling, these surfaces used were tables, floors, sink, wall, bed leg, door handle and beddings. Each of the surfaces mentioned were thoroughly swabbed over an approximate area of 10cm square using horizontal and vertical strokes, while irregular shaped object were swabbed thoroughly over the entire surface, all for a period of two minutes Each of the samples collected was carefully labelled, with the swabbing site, date and time, then transported to the microbiology laboratory. Sample Inoculation The eligible specimens were inoculated on nutrient agar, blood agar, MacConkey agar, Eosin methylene blue agar and Mannitol salt agar. Samples were incubated at 37°C for 24 h. After the incubation period, the isolated colonies were further sub-cultured to get pure colonies. Re-isolation was performed in cases of overlapping growth of different types of bacterial colonies. Identification This was done preliminary by observation of colony morphology, hemolysis on blood agar, lactose fermentation on MacConkey agar, EMB and Mannitol salt agar. Then gram stain was carried out to determine the reaction of the bacteria isolated. Isolates were then grouped as gram positive or gram negative. Biochemical testing carried out were oxidase, catalase, coagulase test, citrate utilization, indole production, motility, urease production, along with specific characteristics on triple sugar iron (TSI) agar. Antimicrobial Susceptibility Testing (AST) This was carried out according to the method described by Clinical laboratory standards institute (CLSI, 2018). Commercial antibiotics disc used was bought from Ariaria international market, manufactured by Optun laboratory Nigeria limited. Antibiotic disc include on the discs were Rifampicin 20ug, Azithromycin 10ug, Erythromycin 30ug, Levofloxacin 20ug, Ciprofloxacin 10ug, Gentamicin 10ug, Streptomycin 30ug, Cefuroxime 30ug, Ceftazidime 30ug, Amoxil 20ug. The bacteria isolates were adjusted to match 0.5 McFarland standards. Using a Pasteur pipette, 0.2ml of the inoculum was evenly distributed using an L shaped ethanol flamed glass rod on the surface of the Muller Hinton agar plates using the spread plate technique. The plate surface was allowed to dry for a few minutes before placing antibiotic disc. The disc was placed on the surface of the agar using sterile forceps. Plates were incubated at 37oC for 24hours after which zones of inhibition surrounding each disc was examined. The diameter of each zone was measured, the zones measured were compared to standards given by CLSI(2020)M100 guidelines and were classified as susceptible, Intermediate or resistant to each antibiotic. 2026
Ekeleme Jessica Ezinne Directive Publications 2026 Determination of Multiple drug resistance (MDR) using the MAR Index MDR in isolates were done according to new standardized international document (Magiorakos et al, 2012) by the results of antimicrobial susceptibility of isolates to all antimicrobial agent listed in 2.7.2, isolates which have shown non-susceptibility to at least one agent in ≥3 antimicrobial categories is considered MDR. MAR Index was calculated as A/B. Where A= number of drugs the bacteria was resistant / total number of drugs the bacteria was exposed to RESULT Bacterial isolates were recovered from various hospital wards in Hospital1 and Hospital 2 . These tests confirmed the presence of key ESKAPE pathogens on surfaces, Escherichia coli (Green metallic sheen on EMB agar), Klebsiella pneumoniae (Muccoid lactose fermenter on MacConkey agar), Staphylococcus aureus (Golden colonies, fermenting mannitol, coagulase positve), Enterobacter sp and Pseudomonas aeruginosa ( Pigment producing oxidase positive). S. aureus had the highest frequency across both hospitals, followed by E. coli, then K. pneumoniae, P. aeruginosa and Enterobacter sp. The highest occurrence was observed in female wards, followed by emergency wards, male wards injection rooms and children’s wards. Table 1. Morphological Characterisitcs Of The Bacteria Isolated. NO.MORPHOLOGY Grm RXN CATOXICOACITMR VPUREINDMOT HE TSI AGAR Suspected bacteria slantbuttgasH 2 S 1 Green metallic sheen colour on Eosin Methylene Blue agar -ve short rods + - - + - - + - β A A + - Esherichia coli 2 Mucoid lactose fermenting, large,2- 3mm round raised colonies on MacConkey agar. -VE rods
+ - + - - + + - - ϒ A A + - Klebsiella pneumoniae 3 Yellowish to golden colored small round colonies, 2mm, shinny and elevated on Nutrient agar. Fermenting manitol on manitol salt agar +VE cocci in clusters + - + + + + + - - β ND ND ND Staphylococcus aureus 4 Small 1-2 colonies, lactose fermenters, on MacConkey Agar. -ve rods in singles + - - + - + - - + α A A + - Enterobacter sp 5 Smooth round colonies, producing bright bluish-green diffusible pigments on Nutrient agar - + - + - - - - + - α AK A + - Pseudomonas aeruginosa KEY: Β Beta hemolysis Α Alpha Hemolysis ϒ Gamma Hemolysis + Positive/present - Negative/Absent AK Alkaline A Acid ND not determines CAT Catalase OXI Oxidase COA Coagulase CIT Citrate MR Methyl red VP Vogues Proskeur URE Urease test IND Indole test MOT Motility test HE Hemolysis test
Directive Publications Ekeleme Jessica Ezinne Figure 1. shows the bacteria with the highest occurrence and it was observed that S. aureus had the highest occurrence in this study, and this was followed by Escherichia coli, then klebsiella pneumoniae and Pseudomonas aeruginosa while the least was Enterobacter species, in all the rooms in both RUTH and ABSUTH. Again, its highest occurrence was however observed in the female wards, followed by Emergency wards, then the male wards, injection room and least in the children’s room. ANTIBIOTIC SUCEPTIBILTY TESTING Table 2 shows the Antibiotic susceptibility patterns of the bacteria from the children’s ward in hospital 2. Drugs used were Rifampicin (RD), Ceftazidime (CTZ), Streptomycin(S), Azithromycin(AZM), Ciprofloxacin(CPX), Erythromycin (E),Levofloxacin(LEV), Gnetamycin (GN), Cefuroxim (CEF), Amoxil(AMX). Result showed that E. coli, Enterobacter sp, K. pneumoniae and S. aureus all had varying degree of resistance to the antibiotics with a mar index of 5(50%), while P. aeruginosa had the highest resistance index of 8 (80%), to these antibiotics. Table 3 shows the Antibiotic susceptibility patterns of the bacteria from the female ward in Hospital 1. Result showed that Enterobacter sp, K. pneumoniae and S. aureus all had varying degree of resistance to the antibiotics with a mar index of 5(50%), 6(60%) and 6 (60%) respectively, while P. aeruginosa and E. coli had the highest resistance index of 8 (80%), to these antibiotics. Table 4 shows the Antibiotic susceptibility patterns of the bacteria from the male ward in hospital 1. Result showed that E. coli, Enterobacter sp, K. pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 6(60%) respectively, S. aureus had a Mar Index of 7(70%) while P. aeruginosa and E. coli had the highest resistance index of 8 (80%), to these antibiotics. Table 5 shows the Antibiotic susceptibility patterns of the bacteria from the male ward in hospital 1. Result showed that E. coli, Enterobacter sp, S. aureus all had varying degree of resistance to the antibiotics with a mar index of 4(40%) respectively, Klebsiella Pneumoniae had a Mar Index of 6(60%). P. aeruginosa again had the highest resistance index of 8 (80%), to these antibiotics. Table 6 shows the antibiotic susceptibility patterns of the bacteria isolated from the Emergency ward in hospital 1. Result showed that E. coli, Klebsiella pneumonia and S. aureus all had varying degree of resistance to the antibiotics with a mar index of 6(60%) respectively, Enterobacter sp had a Mar Index of 5(50%). P. aeruginosa again had the highest resistance index of 9 (90%), to these antibiotics. 2026
Ekeleme Jessica Ezinne Directive Publications 2026 Table 2. Antibiotic susceptibility patterns of the bacteria isolated from the children’s ward in hospital 1. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli I(19)R(8) R(11)R(9) R(12)I(19)S(26)S(27)R(11)S(24)5(50) Enterobacter mori R(0)R(10)R(10)I(19)S(23)I(19)S(26)S(29)R(10)R(11)5(50) Pseudomonas aeruginosa R(0)R(12)R(9) R(13)R(14)R(21)S(28)S(26)R(8) R(12)8(80) Klebsiella pneumoniae I(19)R(12)R(13)I(21)R(14)I(22)S(25)I(27)R(11)R(10)5(50) Saphylococcus aureus R (0)R(14)S(21)R(14)S(24)I(20)S(25)S(28)R(12)R(14)5(50) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 3. Antibiotic susceptibility patterns of the bacteria isolated from the female ward in hospital 1. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli R(0) R(11)R(13)R(9) R(12)I(14)S(22)S(27)R(11)S(24)8(80) Enterobacter mori R(0) R(0)R(12)I(15)R(12)I(17)S(24)S(23)R(14)R(0) 5(50) Pseudomonas aeruginosa R(10)R(10)R(12)R(10)R(10)R(11)S(29)S(25)R(8) R(12)8(80) Klebsiella pneumoniae R(15)R(14)R(10)I(18)R(16)I(20)S(28)I(27)R(13)R(11)6(60) Saphylococcus aureus R(14)R(10)S(23)R(14)R(24)I(21)S(25)S(25)R(12)R(16)6(60) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 4. Antibiotic susceptibility patterns of the bacteria isolated from the MALE ward in hospital 1. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX Escherichia coli I(19)R(8)R(11)R(12)R(23)R(15)S(26)S(29)R(11)S(15)6(60% Enterobacter mori R(0)R(10)R(10)R(15)S(26)I(20)S(30)S(29)R(10)R(11)6(60) Pseudomonas aeruginosa R(0)R(12)R(9)R(13)R(24)R(11)S(26)S(25)R(8) R(12)8(80) Klebsiella pneumonia I(19)R(12)R(13)S(21)R(22)R(12)S(28)S(24)R(10)R(8) 6(60) Saphylococcus aureus R (0)R(14)S(21)R(14)R(24)I(15)S(29)S(28)R(12)R(14)7(70) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 5. Antibiotic susceptibility patterns of the bacteria isolated from the INJECTION ward in hospital 1. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX Escherichia coli R(14)I(18)S(21)I(19)S(29)S(19)S(26)R(10)R(11)R(9)4(40) Enterobacter mori R(0)S(20)R(10)S(19)S(33)S(19)S(26)S(19)R(10)R(11)4(40) Pseudomonas aeruginosa R(0)R(12)R(9)R(13)S(34)S(21)S(28)R(9)R(8) R(12)8(80) Klebsiella pneumoniae R(12)R(12)R(13)S(21)S(34)S(22)S(25)R(10)R(11)R(10)6(60) Saphylococcus aureus R (0)S(14)S(21)R(14)S(27)S(20)S(25)S(28)R(12)R(14)4(40) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 6. Antibiotic susceptibility patterns of the bacteria isolated from the EMERGENCY ward in hospital 1. ISOLATES RD CTZ S AZMCPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli I(19)R(8) R(11)R(9)R(15)I(18)S(27)S(27)R(11)R(0)6(60) Enterobacter mori R(0)R(10)R(10)R(9)R(28)R(11)S(28)S(28)R(25)R(11)5(50) Pseudomonas aeruginosa R(0)R(12)R(9)R(10)R(15)R(21)R(19)S(28)R(8)R(12)9(90) Klebsiella pneumonia I(19)R(12)R(13)R(11)R(18)I(22)S(26)I(25)R(11)R(10)6(60) Saphylococcus aureus R (0)R(14)S(21)R(14)R(20)I(20)S(28)S(25)R(12)R(14)6(60) Numbers in the bracket ()* represents the duplicate values of zones of inhibition
Directive Publications Ekeleme Jessica Ezinne Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 7 shows the Antibiotic susceptibility patterns of the bacteria from the children’s ward in hospital 2. Drugs used were Rifampicin (RD), Ceftazidime (CTZ), Streptomycin(S), Azithromycin(AZM), Ciprofloxacin(CPX), Erythromycin (E),Levofloxacin(LEV), Gnetamycin (GN), Cefuroxim (CEF), Amoxil (AMX). Result showed that E. coli had a mar index of 2(20%), Enterobacter sp. P.earuginosa and k.pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 3 (30%), while S. aureus had the highest resistance index of 4 (40%), to these antibiotics. Table 8 shows the Antibiotic susceptibility patterns of the bacteria from the female ward in hospital 2. Result showed that E. coli had a mar index of 2(20%), Enterobacter sp. P.earuginosa, S. aureus and k.pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 8 (80%), while Pseudomonas aeruginosa had the highest resistance index of 9 (90%), to these antibiotics. Table 9 shows the Antibiotic susceptibility patterns of the bacteria from the male ward in hospital 2. Result showed that E. coli and Enterobacter sp. had a mar index of 7 (70%) k.pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 8 (80%), S. aureus had 6 (60%) and while Pseudomonas aeruginosa had the highest resistance index of 9 (90%), to these antibiotics. Table 7. Antibiotic susceptibility patterns of the bacteria isolated from the children’s ward in hospital 2. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli I(12)S(20)S(21)R(9) S(22)S(24)S(21)S(28)R(13)S(0)2(20) Enterobacter mori R(10)R(14)S(26)I(19)S(26)I(21)S(28)S(19)S(24)R(9)3(30) Pseudomonas aeruginosa R(0) S(20)S(25)R(13)S(27)S(21)S(28)S(26)R(28)R(12)3(30) Klebsiella pneumoniae S(0) S(10)S(22)I(23)R(12)S(24)S(25)I(27)R(11)R(10)3(30) Saphylococcus aureus R (0)S(18)S(24)R(14)S(24)I(15)S(25)S(28)R(12)R(14)4(40) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 8. Antibiotic susceptibility patterns of the bacteria isolated from the female ward in ABSUTH. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX Escherichia coli R(0) R(11)R(0)R(0)R(18)R(14)S(26)S(29)R(11)S(0)8(80) Enterobacter mori R(0) R(0) R(0)R(0)R(17)I(17)S(28)S(26)R(14)R(0)8(80) Pseudomonas aeruginosa R(10)R(10)R(0)R(0)R(21)R(11)S(29)S(27)S(24)R(0)9(90) Klebsiella pneumoniae R(15)R(14)R(0)R(0)R(15)R(10)S(26)S(29)R(13)R(0)8(80) Saphylococcus aureus R(14)R(10)S(0)R(0)R(22)R(11)S(28)S(31)R(12)R(10)8(80) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 9. Antibiotic susceptibility patterns of the bacteria isolated from the MALE ward in ABSUTH. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli I(19)R(8)R(11)R(12)S(29)R(15)S(26)S(29)R(11)R(0) 7(70) Enterobacter mori R(0) R(10)R(10)R(15)S(26)I(20)S(30)S(29)R(10)R(11)7(70) Pseudomonas aeruginosa R(0) R(12)R(9)R(13)R(24)R(11)S(26)S(25)R(8) R(0) 9(90) Klebsiella pneumoniae R(10)R(10)R(15)S(18)R(25)R(12)S(28)S(27)R(10)R(10)8(80) Saphylococcus aureus R (0)R(15)S(11)R(25)S(28)I(15)S(29)S(28)R(12)R(14)6(60) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 10 show the antibiotic susceptibility patterns of the bacteria from the injection ward in ABSUTH. Result showed that E. coli, Enterobacter sp., S. aureus and k.pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 5 (50%), while Pseudomonas aeruginosa had the highest resistance index of 8 (80%), to these antibiotics. Table 11 show the antibiotic susceptibility patterns of the bacteria from the emergency ward in ABSUTH. Result showed that E. coli and 2026
Ekeleme Jessica Ezinne Directive Publications 2026 Enterobacter sp., had varying degree of resistance to the antibiotics with a mar index of 4 (40%), S. aureus and k.pneumoniae all had varying degree of resistance to the antibiotics with a mar index of 5 (50%), while Pseudomonas aeruginosa had the highest resistance index of 9 (90%), to these antibiotics. Table 10. Antibiotic susceptibility patterns of the bacteria isolated from the INJECTION room in ABSUTH. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli R(14)I(18)S(21)I(19)S(29)S(29)S(27)S(25)R(11)R(9) 5(50) Enterobacter mori R(0) S(24)R(10)S(19)S(29)S(19)S(31)S(29)R(22)R(11)5(50) Pseudomonas aeruginosa R(0) R(12)R(11)R(10)R(18)S(21)S(28)R(11)R(8)R(12)5(80) Klebsiella pneumoniae R(12)R(12)S(23)S(24)S(29)S(22)S(25)R(10)R(11)R(10)5(50) Saphylococcus aureus R (0)R(0)S(21)R(14)S(27)S(20)S(25)S(26)R(0)R(0) 5(50) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 11. Antibiotic susceptibility patterns of the bacteria isolated from the EMERGENCY ward in ABSUTH. ISOLATES RD CTZ S AZM CPX E LEV GN CEF AMX MAR INDEX (%) Escherichia coli I(19)R(8) S(21)R(0) S(29)S(28)S(27)S(27)R(11)R(0) 4(40) Enterobacter mori R(0)R(10)S(20)R(9) S(26)S(19)S(28)S(28)S(29)R(0) 4(40) Pseudomonas aeruginosa R(0)R(12)R(9) R(10)R(15)R(1) R(19)S(28)R(8) R(0) 4(90) Klebsiella pneumonia R(9)R(12)R(13)R(11)R(18)I(22)S(26)S(25)S(21)R(0) 5(50) Saphylococcus aureus R (0)R(14)S(21)R(14)R(20)I(20)S(28)S(26)R(12)R(0) 5(50) Numbers in the bracket ()* represents the duplicate values of zones of inhibition Key: R-Resistant; I- intermediate; S-Sensitive; RD= RIFAMPICIN, CTZ= CEFTAZIDIME, S = STREPTOMYCIN, AZM=AZITHROMYCIN, CPX= CIPROFLOXACIN, E= ERYTHROMYCIN, LEV= LEVOFLOXACIN, GN= GENTAMYCIN, CEF= CEFUROXIME, AMX= AMOXIL. Table 12 shows the comparison of the multidrug resistance recorded in the wards of both hospitals and it was observed that there was statistical differences between the children’s wards (0.0186, R= 0.7860), female wards (0.0349,R=0.7111) and emergency wards (0.0243,R=0.4902). These were also the wards with the highest number of AMRs, however there were no significant differences between the male wards (0.1778,R=0.4000) and injection room (0.8149,R=0.01538) from both hospitals. Table 12. Comparison of the Multidrug resistance between the two hospitals. Paired test Children’s ward Female ward Male ward Injection room Emergency ward P. value 0.0186 0.0349 0.1778 0.8149 0.0242 Tailed p value Two-tailed Two-tailed Two-tailed Two-tailed Two-tailed t, df t=3.833 df=4 t=3.138 df=4 t=1.633 df=4 t=0.2500 df=4 t=2.774 df=8 Number of pairs 5 5 5 5 5 Mean differences 2.600 -1.600 -0.8000 0.2000 2.000 ± 0.7211 95% confidence interval 0.7172 to 4.483 -3.015 to -0.1845-2.160 to 0.5600-2.021 to 2.4210.3371 to 3.663 R 0.7860 0.7111 0.4000 0.01538 0.4902 Key p<0.05, it is statistically significant. DISCUSSION The research demonstrates a high burden of multidrug resistant ESKAPE Pathogens in hospital environments of two facilities in Aba, Abia State Nigeria. Both hospitals exhibited an increasing number of AMRs, on the surfaces of fomites examined in the different wards. Phenotypic identification (Table 1) confirmed the presence of key ESKAPE members, with S. aureus most prevalent, this finding is consistent with its strong persistence in the environment and biofilm – forming ability (Uwamariya et al., 2026). ESKAPE Bacteria isolated were E. coli, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterobacter species. The reported organisms isolated in this study agree with those obtained from previous studies as recorded in the work of Agu et al.,(2024). Yallew et al. (2019) reported that Staphylococcus aureus, Pseudomonas aeroginosa, and Klebsiella species are the most common pathogens in Africa isolated from hospital fomites. Another review in Africa
Directive Publications Ekeleme Jessica Ezinne reported Klebsiella, Staphylococcus aureus, Pseudomonas aeroginosa, and E. coli as the most common microorganisms in HAIs (Irek, 2018). These three microorganisms, in addition to being easier to transport than others, have significant resistance to antibiotics. On the other hand, they are more resistant to sterilization and disinfection methods than the others. Due to these characteristics, these microorganisms have a higher prevalence rate than others (Yallewe,et al.,2019). The preponderance of Staphylococcus aureus may be due to its existence as normal flora of the skin and the upper respiratory tract, and its ability to be transmitted via various human activities such as sneezing, talking, and contact with moist skin (Itah and Ben,2020). Susceptibility data reveal widespread resistance, especially to commonly used beta lactams and rifampicin with Pseudomonas aeruginosa emerging as the most challenging organism (MAR above 70%). This is in alignment with the broader African trends where P. aeruginosa frequently exhibits high MDR due to intrinsic mechanisms (efflux pumps, AmpC B-lactamases) and acquired resistance (Khasapane et al.,2025; Mthombeni et al.,2024). MAR indices >0.2 across most isolates indicate high risk contamination sources linked to heavy antibiotic pressure, a common issue in Nigerian and sub-Saharan African hospitals (Ayobami et al.,2022). When the presence of AMR was statistically analysed , it was observed that there were significant differences as P was less than 0.05 (P<0.05) in majority of the wards from both hospitals. Ward specific patterns suggest higher transmission risk in female and emergency wards, while inter hospital differences point to local factors such as varying stewardship practices or cleaning protocols. Lower resistance in some wards is encouraging but still concerning overall.These environmental isolates mirror clinical ESKAPE burdens reported regionally, identifies the hospital environment as a reservoir for nosocomial infections. Findings reinforce the need for strengthened infection prevention and control, antimicrobial stewardship and routine surveillance in source – limited settings. Future work could include molecular characterization of resistance genes and correlation with clinical outcomes. Nosocomial infections create a major problem for health workers because it continues to hinder effective management of health care delivery in hospitals all over the world. According to a study of the literature, hospital-wide HAI prevalence in Africa ranges from 2.5% to 14.8%; on surgical wards, the cumulative incidence varies from 5.7% to 45.8%. CONCLUSION This study has showed that surfaces of inanimate objects in hospital environments serve as reservoirs and vehicle for transmission of nosocomial infections, highlighting critical areas to target in infection prevention strategies. The findings from this study showed a high prevalence of antibiotic- resistant bacteria in the environment, stressing the need for responsible antibiotic usage. Policymakers and public health authorities can use these findings for proper policy development to enforce stricter regulations on antibiotic use and environmental hygiene Declaration of conflict of interest The authors declare no conflict of interest in carrying out this research work. REFERENCES 1. Agu, K. A., Eze, E. A., Okeke, I. N., & Nwankwo, E. O. (2024). Bacterial contamination of hospital fomites and antimicrobial resistance patterns in tertiary healthcare facilities in southeastern Nigeria. Journal of Infection in Developing Countries, 18(2), 245–255. 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