Gram-negative infection in a neonatal intensive care unit: A 13-year single center experience

Neonates admitted to neonatal intensive care units (NICUs) are highly vulnerable to infection due to their critical condition and the need for invasive procedures. This study provides a comprehensive 13-year overview (2011–2023) of the clinical profile, microbiology, antimicrobial resistance, and outcomes of gram-negative infections in a tertiary-care NICU. Among the 94 affected neonates, the majority were preterm and of low birth weight two well-recognized factors that amplify susceptibility to invasive disease. Escherichia coli and Klebsiella species were the most frequently isolated pathogens, reflecting their growing relevance in neonatal sepsis worldwide. Indwelling device tips yielded positive cultures in 22.3% of cases, and 16.0% of neonates had prior colonization with the eventual causative agent, primarily detected in bronchial secretions, illustrating how the complex care required in NICUs can inadvertently facilitate bacterial infection. We verified that 20, 2% of isolated bacteria were multidrug-resistant extended spectrum beta-lactamase (ESBL) producers. Moreover, high rates of resistance to ampicillin were found, underscoring the challenge of selecting effective empiric therapy. More than half of the infections were classified as nosocomial, reflecting the persistent burden of healthcare-associated infections in this setting. Despite advances in neonatal care, infection still contributed to 17% of deaths, reaffirming its substantial impact on survival.