Multidrug-resistant sepsis in special newborn care units in five district hospitals in India: a prospective cohort study.

Summary

In five Indian district hospitals, culture-positive neonatal sepsis occurred in 3.2% of admissions with a 36.6% case-fatality rate. Gram-negative pathogens predominated and 75–88% of key isolates were multidrug resistant, particularly in outborn neonates, highlighting urgent needs for IPC, blood culture capacity, and stewardship.

Key Findings

• Among 6612 neonates, 3.2% had culture-positive sepsis with a 36.6% case-fatality rate.
• Outborn neonates had higher sepsis incidence (5.0%) than inborn (2.0%).
• Gram-negative bacilli comprised 70% of isolates; 75–88% of key species (K. pneumoniae, E. coli, Enterobacter spp., A. baumannii) were multidrug resistant.

Clinical Implications

Implement on-site blood culture and MALDI-TOF capacity, reinforce infection prevention and control, and tailor empiric regimens using local resistance profiles; prioritize outborn neonates for surveillance and early escalation.

Limitations

• Cultures obtained only from neonates meeting prespecified criteria may underestimate true incidence.
• Observational design precludes causal inference about drivers of MDR or mortality.

Future Directions

Scale up district-level microbiology capacity, implement antimicrobial stewardship bundles, and evaluate targeted IPC interventions and empiric therapy optimization in pragmatic trials.