High prevalence of antimicrobial resistance to initial empirical antibiotic therapy in neonatal sepsis in Bengaluru, India—a multicentre study

Data about epidemiologic and microbiologic patterns of neonatal sepsis in specific regions of low- and middle-income countries can help improve management and stimulate prevention efforts. We conducted a multicentre study within a large metropolitan region in South India to describe the burden of neonatal sepsis; and identify the antimicrobial sensitivity patterns of causative organisms. In a collaborative network of six neonatal intensive care units, standardized data were collected on every admitted neonate with a positive blood culture from June 2020 to May 2022. The frequency of sepsis, the organisms, antimicrobial resistance patterns, and mortality were analysed. Factors associated with lack of 'on-target' initial empirical antibiotic therapy were identified through univariate and multivariate analysis. Among 6229 admissions, the incidence of sepsis was 3.5%. Klebsiella (30%), Coagulase-negative staphylococcus (13%), and Escherichia coli (10%) were the commonest organisms. The overall incidence of multidrug resistance among Gram-negative organisms was 26%, with organism-specific incidence as follows: Klebsiella (48%), Acinetobacter (81%), and E. coli (45%). The organisms were sensitive to one or more of the initial empirical antibiotics used ('on-target') in 48% [95% confidence interval (CI) 45-58%] of cases. Mortality was higher in those neonates where initial antibiotic therapy was not 'on-target' (Relative risk (RR): 2.2, 95% CI 1.06-4.9). To conclude gram-negative septicaemia constituted 60% of the burden of neonatal sepsis. Klebsiella pneumonia was the predominant organism. Multidrug resistant organisms were highly prevalent. Initial empirical antibiotic therapy was not 'on-target' more than 50% of the time and was associated with higher mortality.