Bacteriological Profile, Antimicrobial Susceptibility, and Clinical Outcomes of Neonatal Bloodstream Infections in a Tertiary Care Centre in Central India: A Prospective Cohort Study

Background: Neonatal sepsis is a major cause of morbidity and mortality, especially in low- and middle-income countries, where the emergence of multidrug-resistant (MDR) pathogens complicates empirical treatment. Accurate, region-specific epidemiological data are critical to guide antimicrobial therapy and enhance survival rates. The study aimed to determine the bacteriological profile of blood-culture-proven neonatal sepsis, determine the antimicrobial susceptibility patterns of the isolated pathogens, and evaluate the associated clinical outcomes in a tertiary care setting. Material and Methods: A one-year, observational, prospective cohort study was conducted at a Special Newborn Care Unit (SNCU) in central India, enrolling 150 neonates with culture-proven bacterial bloodstream infections. Demographic, clinical, and laboratory parameters were systematically recorded. Pathogen identification and antibiotic susceptibility testing were performed following standard Clinical and Laboratory Standards Institute (CLSI) protocols. Results: The majority (75.3%) were preterm, and 47.3% very low birth weight with early-onset sepsis as most common presentation (65.3%). The isolate profile consisted of mainly resistant Gram-negatives (68.7%), primarily driven by Acinetobacter spp. (22.0%) and Klebsiella pneumoniae (21.3%), which are highly multidrug-resistant to first-line agents but only moderately sensitive to colistin (50.5%) and had a 3.3% pandrug-resistance rate, with case fatality rate overall at 21.3%, the major cause being Gram-negative infections or extreme prematurity. Conclusion: Neonatal sepsis in this region is critically burdened by extensively resistant Gram-negative bacteria. The alarming emergence of pan-resistant strains demands immediate implementation of rigorous antimicrobial stewardship and targeted infection control bundles in neonatal units.

Keywords: Neonatal sepsis, antimicrobial resistance, Klebsiella pneumoniae, Acinetobacter, Pandrug-resistance.