Pathogen distribution and antimicrobial resistance among neonatal bloodstream infections in Southeast Asia: results from NeoSEAP, a multicentre retrospective study

Abstract

Background

Progress in reducing morbidity and mortality due to neonatal sepsis has slowed in recent decades and is threatened by the global rise of antimicrobial resistance. The populous Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance (AMR). Despite this, there remains a lack of robust data on the epidemiology of neonatal sepsis and the prevalence of AMR within the region.

Methods

We evaluated positive blood cultures and susceptibility profiles responsible for neonatal sepsis across 10 clinical sites in five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia, and Vietnam). Retrospective data on all blood cultures collected from neonates over two years (1st January 2019–31st December 2020) were extracted from laboratory records. Data were also collected on the availability and implementation of infection prevention and control resources, and antimicrobial prescribing practices. Pooled estimates across sites and pathogens were generated, with adjustment for clustering.

Findings

Of 14,804 blood cultures collected over the study period, a total of 2131 positive isolates (including 1483 significant pathogens) were identified. Gram-negative bacteria predominated as causative of neonatal sepsis (78·4%; 1163/1483) with Klebsiella spp. (408/1483; 27·5%) and Acinetobacter spp. (261/1483; 17·6%) most frequently isolated overall. Adjusted pooled non-susceptibility for Klebsiella spp. was 86·7% (95% CI 54·0–98·5) for third-generation cephalosporins (ceftriaxone and/or cefotaxime; 3GC) and 17·1% (95% CI 8·1–24·7) for carbapenems; while non-susceptibility for Escherichia coli was 46·4% (95% CI 20·0–72·0) for 3GC and 15·4% (95% CI 2·7–31·0) for carbapenems. Carbapenem non-susceptibility for Acinetobacter spp. was 76·5% (95% CI 59·4–84·5). Gram-positive bacteria accounted for 13·2% (196/1483) of pathogens causative of neonatal sepsis, whilst Candida spp. accounted for 8·3% (123/1483) of culture-positive sepsis episodes.

Interpretation

Neonatal sepsis in tertiary hospitals in Southeast Asia is predominantly caused by gram-negative bacteria, with high rates of non-susceptibility to commonly prescribed antibiotics.

Funding

This study was supported by an Australian National Health and Medical Research Council (NHMRC) grant. The NHMRC was not involved in the design or conduct of the research.