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

Benjamin F. R. DicksonSchool of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, AustraliaM. HarrisonSydney Institute for Infectious Diseases, The University of Sydney, Sydney, AustraliaMaria Esterlita T. Villanueva-UyInstitute of Child Health and Human Development, National Institutes of Health, Manila, PhilippinesNina Dwi PutriUniversitas Indonesia, Jakarta, IndonesiaRiyadi AdrizainHasan Sadikin General Hospital, Bandung, IndonesiaLeny KartinaUniversity of Airlangga, Surabaya, IndonesiaGayana P. S. GunaratnaColombo South Teaching Hospital, Colombo, Sri LankaHoang Thi TranDepartment of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang, VietnamNguyễn Thị Thu HươngPhan Chau Trinh University, Quang Nam, VietnamSiew Moy FongSabah Women's and Children's Hospital, Sabah, MalaysiaErena S. KasaharaPhilippine General Hospital, Manila, PhilippinesDistyayu SukarjaCipto Mangunkusumo Hospital, Jakarta, IndonesiaTetty YuniatiHasan Sadikin General Hospital, Bandung, IndonesiaMartono Tri UtomoUniversity of Airlangga, Surabaya, IndonesiaNambage Shirani ChandrasiriColombo South Teaching Hospital, Colombo, Sri LankaChau Hoang Minh LeDa Nang University of Medical Technology and Pharmacy, Da Nang, VietnamNguyễn Thị Kiều TrinhPhan Chau Trinh University, Quang Nam, VietnamNarei HongSabah Women's and Children's Hospital, Sabah, MalaysiaHoang Nguyen Thanh ThuyDa Nang Tam Tri General Hospital, Da Nang, VietnamTran Thi Cam TuNha Trang Tam Tri General Hospital, Nha Trang, VietnamLe Tuyet HongDong Thap Tam Tri General Hospital, Dong Thap, VietnamJannah BakerSchool of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, AustraliaMark JonesSchool of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, AustraliaTom SnellingSchool of Public Health, Faculty of Medicine & Health, The University of Sydney, Sydney, AustraliaMike SharlandSt George's University, London, United KingdomPhoebe WilliamsSydney Institute for Infectious Diseases, The University of Sydney, Sydney, Australia

The Lancet Regional Health - Western Pacificjournal2025en

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ABI

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<h2>Summary</h2><h3>Background</h3> 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. <h3>Methods</h3> 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. <h3>Findings</h3> 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 <i>Klebsiella</i> spp. (408/1483; 27·5%) and <i>Acinetobacter</i> spp. (261/1483; 17·6%) most frequently isolated overall. Adjusted pooled non-susceptibility for <i>Klebsiella</i> 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 <i>Escherichia coli</i> 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 <i>Acinetobacter</i> 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 <i>Candida</i> spp. accounted for 8·3% (123/1483) of culture-positive sepsis episodes. <h3>Interpretation</h3> 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. <h3>Funding</h3> 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.

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Neonatal and Maternal Infections Sepsis Diagnosis and Treatment Bacterial Identification and Susceptibility Testing

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DOI: 10.1016/j.lanwpc.2025.101617

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