High burden of anti-microbial resistance among neonatal blood stream infections in Southeast Asia: results of the NeoSEAP study

Background Progress on neonatal sepsis has remained modest in recent decades and is threatened by the global rise of antimicrobial resistance. The Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance. Despite this, their remains a lack of robust epidemiological data on the causes of neonatal sepsis and the prevalence of AMR in the region. Methods We evaluated the causes of neonatal sepsis and AMR burden in 10 sites across five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia and Vietnam). Retrospective data on all blood cultures collected from neonates between 1st January 2019 – 31st December 2020 were extracted from laboratory records. Data were also collected on the availability of clinical resources, the implementation of infection prevention and control strategies, and antimicrobial prescribing practices. Findings A total of 1,528 blood cultures were positive for significant isolates over the study period. Gram-negative pathogens predominated (1,163/1,528, 76.1%) with the most frequently isolated pathogens Klebsiella spp. (408/1,528, 26.7%) and Acinetobacter spp. (261/1,528, 17.08%) Among Gram-negative Enterobacteriaceae pooled resistance to ampicillin, gentamicin, third-generation cephalosporins (ceftriaxone and/or cefotaxime) and carbapenems was 75% (193/257), 59% (393/665), 67% (441/655) and 18.6% (125/672). For Gram negative non-Enterobacteriaceae resistance to gentamicin and carbapenems was 76.6% (326/282) and 69.7% (207/297). Interpretation Neonatal sepsis among study sites was caused predominantly by Gram-negative pathogens and associated with high levels of non-susceptibility to common empirical treatment regimes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by an Australian National Health and Medical Research Council (NHMRC) grant. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was obtained from Universitas Indonesia, Jakarta; Institutional research board, Dr. Soetomo Hospital, Surabaya (0339/KEPK/XII/2021); and Komite Etik Penelitian RSUP Dr. Hasan Sadikin, Bandung. Because the study was clinical audit, a waiver of participant consent was approved by the HREC committees at each site, and a waiver of ethical approval was granted for the Tam Tri Hospital Network I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors