Culture Positive Neonatal Sepsis - A Retrospective Analysis of Clinical Profile, Microbial Pattern and Outcome in a Tertiary NICU in Chennai

Background: Neonatal sepsis continues to be a leading cause of morbidity and mortality, particularly in preterm and low birth weight infants. The spectrum of organisms and their resistance patterns vary across centres, making local data essential to guide management. Aim: To describe the clinical profile, microbial pattern and outcomes of culture-positive neonatal sepsis in a tertiary NICU in Chennai. Methodology: This retrospective study included all neonates with positive blood cultures admitted to the NICU of Government RSRM Lying-In Hospital, Stanley Medical College, between January and December 2024. Demographic data, risk factors, clinical features, organism profile, antibiotic sensitivity, hospital stay and outcomes were analysed. Results: In this study 68 neonates were studied, of whom 57.4% were male. Nearly 80% were preterm and more than 80% had a birth weight below 2.5 kg. Late-onset sepsis was more frequent (61.8%) than early-onset sepsis (38.2%). Klebsiella pneumoniae (22.1%) and Acinetobacter baumannii (16.2%) were the most common Gram-negative isolates, while Enterococcus faecalis (16.2%) and Staphylococcus haemolyticus (13.2%) were the predominant Gram-positives. Gram-negatives showed high resistance to first-line agents; carbapenems and colistin were the most effective, whereas vancomycin and linezolid were reliable against Gram-positives. The mean hospital stay was 14.2 ± 6.5 days (EOS: 11.6 ± 5.2; LOS: 15.8 ± 7.4). Overall mortality was 16.2%, with higher fatality in multidrug-resistant Gram-negative and fungal infections. Conclusion: Culture-positive neonatal sepsis in our unit was closely linked to prematurity, low birth weight and invasive procedures. Gram-negative organisms predominated and contributed to most deaths, highlighting the need for updated local antibiograms, infection-control bundles and strict antibiotic stewardship to improve outcomes in this vulnerable population.