Original Article

Pattern and trend of bacterial resistance in neonatal sepsis in infants admitted to the neonatal intensive care unit, from 2016 to 2021

Abstract

Background and Objectives: Neonatal septicemia is a significant cause of morbidity and mortality in neonatal intensive care units (NICUs). Understanding the patterns of antibiotic resistance and pathogen prevalence is crucial for effective treatment.
Materials and Methods: This cross-sectional study was conducted from 2016 to 2022 in the NICU of Vali-Asr Hospital in Tehran. All neonates diagnosed with septicemia were included. Data were collected using the hospital's registry system.
Results: A total of 477 infants were hospitalized with sepsis, with 71.7% classified as early-onset sepsis (EOS) and 28.3% as late-onset sepsis (LOS). The most common pathogens were coagulase-negative Staphylococcus (22.1%), Klebsiella pneumoniae (14.9%), and Staphylococcus epidermidis (14.3%). The highest antibiotic resistance was observed for erythromycin (89.8%), clindamycin (80.6%), gentamicin (66.1%), and ciprofloxacin (63.5%), while vancomycin showed the lowest resistance (11.2%). Significant associations were found between antibiotic resistance with low birth weight and chest tube intervention. Trends in antibiotic resistance varied over the study period, with a notable decrease in resistance in 2021.
Conclusion: The study highlights the high prevalence of antibiotic resistance in neonatal sepsis, emphasizing the need for continuous monitoring and tailored antibiotic stewardship programs. The findings underscore the importance of individualized treatment approaches to improve outcomes for neonates with sepsis.

1. Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005; 90: F220-F224.
2. Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child 2021; 106: 745-752.
3. Attia Hussein Mahmoud H, Parekh R, Dhandibhotla S, Sai T, Pradhan A, Alugula S, et al. Insight into neonatal sepsis: an overview. Cureus 2023; 15(9): e45530.
4. Kuhl DA. Current strategies for managing the patient with sepsis. Am J Health Syst Pharm 2002; 59 Suppl 1: S9-S13.
5. Scheurer JM, Fanta ML, Colbenson GA, Arbefeville S, Ferrieri P. Early-onset neonatal sepsis caused by vertical transmission of Pasteurella multocida. AJP Rep 2022; 12(2): e123-e126.
6. Barcellini L, Bresesti I, Folgori L. Neglected populations not to be Forgotten: Tackling antimicrobial resistance in Neonatal infections. Antibiotics (Basel) 2023; 12: 1688.
7. Moftian N, Rezaei-Hachesu P, Arab-Zozani M, Samad-Soltani T, Esfandiari A, Tabib MS, et al. Prevalence of gram-negative bacteria and their antibiotic resistance in neonatal sepsis in Iran: a systematic review and meta-analysis. BMC Infect Dis 2023; 23: 534.
8. Shariat M, Youssefkhani AB, Dalili H, Hajinasab N, Farrokhzad N, Nozarian Z, et al. Associated factors and common Pathogens of positive cultures in infants with Definitive Septicemia Admitted to NICU. Acta Med Iran 2023; 61: 355-360.
9. Akbarian-Rad Z, Riahi SM, Abdollahi A, Sabbagh P, Ebrahimpour S, Javanian M, et al. Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens. PLoS One 2020; 15(1): e0227570.
10. Saeidi F, Kialashaki A, Sadighi A, Bahadori A, Valizadeh S, Hosseini M, et al. A Survey of the Prevalence Rate and Antibiotic resistance pattern of Microbial agents in Preterm Neonatal Sepsis. Arch Pediatr Infect Dis 2023; 12(1): e137546.
11. Rashmi P, Praveen B. Clinico-bacteriological profile of neonatal sepsis. Int J Contemp Pediatr 2019; 6: 796-802.
12. Ullah O, Khan A, Ambreen A, Ahmad I, Akhtar T, Gandapor AJ, et al. Antibiotic sensitivity pattern of bacterial isolates of neonatal septicemia in Peshawar, Pakistan. Arch Iran Med 2016; 19: 866-869.
13. Sherif M, Abera D, Desta K. Prevalence and antibiotic resistance pattern of bacteria from sepsis suspected neonates at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Pediatr 2023; 23: 575.
14. Afsharpaiman S, Torkaman M, Saburi A, Farzaampur A, Amirsalari S, Kavehmanesh Z. Trends in incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care units in Tehran, IR Iran. J Clin Neonatol 2012; 1: 124-130.
15. Gerdes JS. Diagnosis and management of bacterial infections in the neonate. Pediatr Clin North Am 2004; 51: 939-959.
16. Kim F, Polin RA, Hooven TA. Neonatal sepsis. BMJ 2020; 371: m3672.
17. You T, Zhou Y-R, Liu X-C, Li L-Q. Risk factors and clinical characteristics of neonatal acute respiratory distress syndrome caused by early onset sepsis. Front Pediatr 2022; 10: 847827.
18. Karimi F, Lewis LE, Thunga G, Najmi A, Sahu P, Kunhikatta V. Relationship between antibiotic consumption pattern and antibiotic resistance in neonatal sepsis. Med Pharm Rep 2023; 96: 35-40.
Files
IssueVol 17 No 4 (2025) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v17i4.19226
Keywords
Sepsis Neonatal Drug resistance Bacterial Intensive care units Klebsiella pneumonia Staphylococcus Coagulase-negative Microbial sensitivity tests
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Naddaf A, Ansari Nasab M, Shariat M, Sadeghi-Moghaddam P, Salarvand S, Omidi Z, Sadat Kosari N, Sahebi L. Pattern and trend of bacterial resistance in neonatal sepsis in infants admitted to the neonatal intensive care unit, from 2016 to 2021. Iran J Microbiol. 2025;17(4):528-538.