Bacterial Isolates, Antibiogram, and Outcomes of Blood Culture Proven Sepsis in Neonates at a Tertiary Hospital in Dar es Salaam, Tanzania: A Retrospective Study

Background Neonatal sepsis (NS) is a leading cause of mortality in low‐resource settings, with empirical therapy challenged by evolving antimicrobial resistance (AMR). Current data from Tanzania’s largest referral hospital are outdated. Objective To determine the contemporary bacteriological profile, antibiotic susceptibility patterns, clinical outcomes, and independent predictors of blood culture‐proven NS at Muhimbili National Hospital (MNH). Methods A retrospective cross‐sectional study was conducted from January to August 2025, reviewing records of 137 neonates with suspected sepsis. Blood cultures were processed using BACTEC; susceptibility testing followed CLSI guidelines. Data were analyzed using SPSS v29. Multivariable logistic regression identified independent predictors. Results Culture‐proven sepsis prevalence was 24.8% (34/137; 95% confidence interval [CI]: 17.8%–32.9%). Predominant isolates were Klebsiella pneumoniae (35.3%), Escherichia coli (23.5%), and Staphylococcus aureus (23.5%). All K. pneumoniae were ESBL producers; all S. aureus were MSSA. Universal resistance to ampicillin and cephalosporins was observed. Independent predictors were lower gestational age (adjusted odds ratios [aOR] 0.65 per week, 95% CI 0.48–0.88), cesarean delivery (aOR 8.21, 95% CI 2.10–32.15), and maternal chorioamnionitis (aOR 15.40, 95% CI 1.42–167.20). Septic neonates had longer NICU stays (8.0 vs. 5.0 days, p < 0.001), higher ventilation needs (50% vs. 0%, p < 0.001), and increased mortality (8.8% vs. 0%, p = 0.014). Conclusion K. pneumoniae and S. aureus dominate NS, with resistance rendering first‐line ampicillin and cephalosporins ineffective. Prematurity, cesarean delivery, and chorioamnionitis are independent risk factors. Findings highlight the need for periodic review of empirical therapy protocols and strengthened antimicrobial stewardship.