Prevalence of Multidrug-Resistant Gram-Negative Bacilli Causing Neonatal Sepsis: A Retrospective Study in a Tertiary Care Hospital From Eastern India.

BACKGROUND

Neonatal sepsis is considered one of the major causes of morbidity and mortality in low and middle-income countries, with a rising burden of multidrug-resistant (MDR) gram-negative bacilli (GNB). The emergence of antimicrobial resistance (AMR) has significantly compromised treatment outcomes in neonatal intensive care units (NICUs). This study aimed to determine the prevalence, antibacterial susceptibility patterns, and associated risk factors of MDR GNB among septic neonates over a four-year period.

MATERIALS AND

METHODS

A retrospective study was carried out from January 2021 to December 2024 in a tertiary care health setting in India. Data regarding septic neonates were retrieved from NICU records, and culture details were retrieved from the LIS (laboratory information system). Blood and cerebrospinal fluid (CSF) samples from neonates with clinically suspected sepsis were processed using the BACT/ALERT® three-dimensional (3D) system (bioMérieux SA, Marcy-l'Étoile, France). Identification and antibiotic sensitivity testing were done by the VITEK® 2 Compact automated system (bioMérieux SA), and interpretation was done as per standard microbiological protocol. Demographic, clinical, and bacterial profile data were analysed using the IBM SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, New York, United States)

Results

Altogether 2,670 neonates were admitted to the NICU during the study period. Out of 424 culture-positive samples, 201 (47.4%) were gram-negative isolates. The most prevalent bacteria were Klebsiella pneumoniae (26.4%), followed by Acinetobacter spp. (23.9%), and Escherichia coli (10.4%). The highest number of MDR strains was observed in K. pneumoniae isolates (73.6%), followed by E. coli (61.9%). K. pneumoniae showed better sensitivity to trimethoprim/sulfamethoxazole (57.64%) and gentamicin (53.13%), Acinetobacter spp. to minocycline (77.4%) and ciprofloxacin (66.7%), and E. coli to gentamicin (60%) and carbapenems (50%). Neonates with low birth weight (LBW) and very low birth weight (VLBW) showed a higher proportion of MDR infections than extremely low-birth-weight neonates (ELBW) (p= 0.02). These observations emphasize the importance of implementing antimicrobial surveillance and tailored antibiotic strategies in managing neonatal sepsis.

CONCLUSION

The findings highlight the predominance of MDR GNB in neonatal sepsis and emphasize the need for species-specific antibiotic strategies with continuous resistance monitoring.