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Updated: Jan 6, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Prevalence of Multidrug-Resistant Gram-Negative Bacilli Causing Neonatal Sepsis: A Retrospective Study in a Tertiary
Rajesh K Dash1, Santosh K Panda2, Shradha Smriti1
1Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
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.
Insights
Multidrug-resistant gram-negative bacilli (MDR GNB) are a major threat in neonatal sepsis, particularly in low-income countries. This study identified key bacterial culprits and their resistance patterns, highlighting the need for targeted antibiotic strategies.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Neonatal Care
Background:
- Neonatal sepsis poses a significant global health challenge, especially in low and middle-income countries.
- The increasing prevalence of multidrug-resistant (MDR) gram-negative bacilli (GNB) complicates treatment and increases mortality in neonatal intensive care units (NICUs).
Purpose of the Study:
- To determine the prevalence of MDR GNB among neonates with sepsis.
- To analyze the antibiotic susceptibility patterns of these MDR GNB isolates.
- To identify risk factors associated with MDR GNB infections in neonates.
Main Methods:
- A retrospective study was conducted in India from 2021 to 2024.
- Blood and cerebrospinal fluid samples from 2,670 neonates were analyzed.
- Bacterial identification and antibiotic susceptibility testing were performed using automated systems (BACT/ALERT® 3D and VITEK® 2 Compact).
Main Results:
- Out of 424 culture-positive samples, 201 (47.4%) were GNB.
- The most common MDR GNB were *Klebsiella pneumoniae* (26.4%), *Acinetobacter spp.* (23.9%), and *Escherichia coli* (10.4%).
- High resistance rates were observed, with *K. pneumoniae* showing 73.6% MDR, and *E. coli* 61.9%. Low birth weight neonates had a higher proportion of MDR infections (p=0.02).
Conclusions:
- MDR GNB are predominant pathogens in neonatal sepsis in the studied population.
- Species-specific antibiotic susceptibility patterns necessitate tailored treatment strategies.
- Continuous antimicrobial resistance monitoring is crucial for effective neonatal sepsis management.
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