Escalating Burden of Multidrug-Resistant Neonatal Sepsis

Neonatal sepsis because of multidrug-resistant (MDR) organisms is an increasing concern, with Southeast Asia facing the highest burden. Evidence remains limited, but available studies reveal alarming resistance patterns. Chaurasia et al. found that nearly 70% of Klebsiella and 54% of Escherichia coli (E. coli) were MDR, with carbapenem resistance in 10% and 8%, respectively.

More recent data show even higher figures, with 85% MDR prevalence and carbapenem resistance reaching 55% in Klebsiella and 12% in E. coli, of which nearly 80% were extended-spectrum beta-lactamase producers.

Govindaraju et al. studied antibiotic resistance in neonates in South India at a private tertiary care hospital. Over eight years, 210 neonates had 216 positive blood cultures. Klebsiella (39%) and E. coli (9%) were the most common organisms, with possible carbapenemase production in about 40% of Klebsiella and 5% of E. coli isolates. Notably, all tested Klebsiella strains carried New Delhi metallo-beta-lactamase, confirming the rapid spread of these highly resistant organisms even in early life.

Treating MDR infections, especially carbapenem-resistant Enterobacteriaceae (CRE), is difficult because options are few. Colistin is often used first, but it is risky as it drives resistance. Current guidance recommends targeted therapy guided by sensitivity, with newer beta-lactam/beta-lactamase inhibitor drugs like ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam preferred to reserve colistin for only the most resistant cases.

In this study, colistin and aminoglycosides were used as first-line therapy in neonates with CRE, raising concern. New agents hold promise, but misuse may fuel resistance. Antimicrobial resistance is a growing shadow pandemic, and urgent steps are needed to safeguard newborns.

Reference:

Kainth D, Thukral A. The Looming Threat of Multidrug-Resistant Neonatal Sepsis–A Wake-Up Call. Indian Journal of Pediatrics. 2025 May 14:1-2.

https://link.springer.com/article/10.1007/s12098-025-05562-2