Surveillance of bacterial colonization and infection in high-risk neonates admitted to tertiary referral hospital in Indonesia.

BACKGROUND

Neonatal mortality remains high in Indonesia, particularly at our center, Dr. Hasan Sadikin General Hospital, where sepsis is the most common cause of death. However, data on colonization dynamics-which are essential for preventing Multi-drug Resistance Organism (MDRO) acquisition-remain limited, particularly in lower-middle income country (LMIC). This study aims to investigate the dynamics of bacterial colonization among high-risk neonates and determine the pattern and timing of MDRO acquisition.

METHODS

Between May and December 2025, 46 neonates were included in this prospective cohort study.

RESULTS

MDRO colonization was detected in 32 neonates (69.6%) who were hospitalized for ≥ 48 h in patient. Outborn neonates had significantly higher risk of MDRO colonization compared with inborn neonates (RR 1.61; 95% CI 1.11-2.33; p = 0.018), with 93.3% outborn neonates testing positive for MDRO colonization. From 146 samples, 110 bacterial isolates were identified, 80 of these (72.7%) were MDROs, the predominant MDRO isolates were Klebsiella pneumoniae and Escherichia coli, including carbapenem-resistant and ESBL-producing strains. MDRO colonization was detected at admission and increased dynamically during hospitalization particularly among outborn neonates. Blood cultures were performed for 21 neonates with suspected infection, of these, 8 (38.1%) were positive, and 5 (62.5% of the positive cultures) yielded MDROs.

CONCLUSIONS

These findings highlight the importance of routine surveillance and consistent adherence to infection prevention control measures, including standard cleaning and disinfection protocols. Regular evaluation of separation between inborn and outborn units also essential to reduce the burden of MDROs and improve neonatal outcomes.