Extensively drug-resistant gram-negative sepsis in a neonatal intensive care unit from western India: A retrospective cohort study

Background and objectives Extensively drug-resistant (XDR) Gram-negative bacterial sepsis is an emerging threat in neonatal intensive care units (NICU). We aimed to determine the epidemiology, pathogen profile, and outcome of neonates with XDR Gram-negative sepsis. Methods This retrospective cohort study was conducted in a newly established NICU in Western India. Data of all neonates admitted between July 2016 and June 2021 were analysed. Standard CDC definitions were used to classify antimicrobial resistance. Results Among 1230 neonates, 31.4% (n=387) had clinically suspected sepsis and 11.5% (n=141) had culture-positive sepsis, accounting for 194 sepsis episodes. Gram-negative sepsis occurred in 117 neonates, of whom 38.4% (45/117) had XDR Gram-negative sepsis. One-third of these isolates were XDR, predominantly Klebsiella (n=21,44%), Acinetobacter (n=18,37%), and Escherichia species (n=6, 13%). Nearly 60% (28/48) of XDR Gram-negative isolates were obtained from outborn neonates, and 60% (n=17) were isolated within 48 h of admission. Mortality was significantly higher in neonates with XDR sepsis (21/45, 46.7%) compared with multidrug-resistant (13/41, 31.7%) and drug-sensitive Gram-negative sepsis (4/31, 12.9%) (P=0.009). Interpretation and conclusions The high burden of extensively drug-resistant Gram-negative sepsis and its association with increased mortality underscore the urgent need for strengthened antimicrobial stewardship and surveillance in neonatal intensive care units.