MDRO infections in the NICU- The international perspective.

Neonatal sepsis due to Multidrug resistant organisms (MDRO) is a huge burden in resource limited settings of South Asia and Africa. The epidemiology, risk factors, diagnostic and management challenges differ significantly in the resource limited settings as compared to the resource rich settings, particularly for Gram-negative MDROs. Lack of diagnostic facilities, limited access to therapeutic options, inability to effectively control horizontal transmission in the neonatal care units due to limited resources are major hurdles in combating MDRO infections in neonates. The low sensitivity of gold standard blood cultures and paucity of pharmacokinetic data in neonates make the overall picture grim. Research studies over the past decade have identified high resistance to the first line and second line treatment regimens recommended by the World Health Organisation (WHO). The progress towards finding customised solutions has been slow. Novel betalactam-betalactamase antibiotics are effective against several MDROs but are expensive. Repurposed antibiotics like fosfomycin and flomoxef hold promise as therapeutic options. The continued critical gaps need to be urgently addressed as national priorities and through international support and cooperation.