Neonatal Sepsis: Current Trends in Antibiotic Resistance and Management Protocols

Abstract:

Background: Neonatal sepsis—a systemic infection occurring within the first 28 days of life—remains a formidable challenge in neonatal intensive care units (NICUs). Despite medical advancements, the emergence of multidrug-resistant (MDR) pathogens has compromised the efficacy of standard empirical antibiotic regimens, leading to increased morbidity and healthcare costs.

Objective: This review summarizes the changing bacteriological profile of neonatal sepsis and evaluates the current global and national protocols for its management in the face of rising antimicrobial resistance (AMR).

Methods: Data from recent surveillance reports and clinical trials were analyzed, focusing on the prevalence of Early-Onset Sepsis (EOS) and Late-Onset Sepsis (LOS) in developing countries.

Discussion: The microbial landscape is shifting from Group B Streptococcus to Gram-negative organisms such as Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. A concerning trend is the high prevalence of Extended-Spectrum Beta-Lactamase (ESBL) producing strains and Carbapenem-resistant Enterobacteriaceae (CRE). The review discusses the limitations of the traditional Ampicillin-Gentamicin duo and evaluates the role of "reserve" antibiotics like Colistin and Meropenem. Furthermore, the importance of Antimicrobial Stewardship (AMS) is emphasized to prevent the "post-antibiotic era" in neonatology. The role of adjunct therapies, including intravenous immunoglobulins (IVIG) and probiotics for prevention, is also examined.

Conclusion: Effective management of neonatal sepsis requires a dual approach: rapid molecular diagnostics for early pathogen identification and strict adherence to antibiotic stewardship. Strengthening infection control practices in labor rooms and NICUs is the most cost-effective strategy to combat AMR and improve neonatal survival rates.

Keywords: Neonatal Sepsis, Antibiotic Resistance (AMR), Klebsiella pneumoniae, ESBL, NICU, Antimicrobial Stewardship, Newborn Health.