Blood culture-proven neonatal sepsis and resistance trends in a tertiary NICU: A retrospective study

Objectives: Neonatal sepsis is a major cause of mortality in India, with an increasing burden of multidrug-resistant (MDR) pathogens complicating management. Unit-specific data on microbial profiles and resistance trends are crucial to guide empiric therapy and improve outcomes. Material and Methods: This retrospective observational study was conducted in the Department of Paediatrics, Karnataka Medical College and Research Institute, Hubballi, from January to March 2025. All neonates with blood culture-positive sepsis admitted to the neonatal intensive care unit (NICU) during the study period were included ( n = 73). Demographic, clinical and microbiological data were extracted from records. Antibiotic sensitivity patterns of carbapenems were compared with those of cephalosporins, aminoglycosides, and fluoroquinolones. Outcomes were assessed in terms of survival or mortality. Results: Of 2,796 neonates delivered, 1,013 were admitted to the NICU, 542 were suspected of sepsis, and 73 (13.4%) had culture-proven infection. Most affected neonates were preterm (83.6%), and early-onset sepsis accounted for 57.5% of cases. Gram-negative organisms predominated (74%), with Klebsiella spp. (50.7%) and Acinetobacter spp. (23.3%) being most common. Carbapenems showed the highest efficacy (meropenem 96.4% and imipenem 96.2%), while cephalosporins (cephalosporins 96.2%), while cephalosporins (<3%) early-onset sepsis accounted for 57.5% of cases. Gram-n%, primarily among preterm infants and those infected with MDR organisms. Conclusion: Gram-negative pathogens, especially Klebsiella and Acinetobacter , dominate neonatal sepsis in this NICU. Carbapenems remain the most reliable therapeutic agents, though rising resistance underscores the urgent need for antimicrobial stewardship, rapid diagnostics and robust infection prevention measures to improve neonatal survival.