Neonatal Sepsis from 2014 to 2024: The Resurgence of Gram-Negative Rods

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Public Health

Background:

• Neonatal sepsis remains a significant cause of morbidity and mortality globally.
• Understanding evolving pathogen trends and risk factors is crucial for improving neonatal outcomes.

Purpose of the Study:

• To assess neonatal sepsis incidence, pathogens, clinical features, and outcomes from 2014-2024.
• To compare current data with historical institutional records.
• To analyze long-term trends in neonatal sepsis since 1928.

Main Methods:

• Retrospective cohort study of infants with bloodstream infections (2014-2024).
• Prospective episode documentation and retrospective data collection.
• Univariate and multi-regression analyses, comparing two epochs (2004-2013 vs. 2014-2024).

Main Results:

• 250 sepsis episodes in 233 infants (2014-2024).
• Increased gram-negative organisms in early-onset sepsis (EOS), notably E. coli, especially in late preterm/term neonates and VLBW infants.
• Late-onset sepsis (LOS) showed lower incidence but increased severity and mortality (11% to 25%), with gram-negative bacteria rising to 50% (2020-2024).
• Sepsis-related mortality increased steadily over three decades; predictors included lower birth weight, pressor use, NEC, and thrombocytopenia.

Conclusions:

• A sustained increase in gram-negative pathogens, particularly E. coli, for both EOS and LOS.
• Decreasing gestational age and increasing baseline illness severity contribute to rising sepsis-related mortality.
• Urgent strategies are needed to address the changing epidemiology of neonatal sepsis.