article · PLoS ONE
A study at a tertiary hospital in Ethiopia investigated antimicrobial resistance among 119 newborns diagnosed with gram-negative bacteremia. Klebsiella pneumoniae was the most common pathogen, followed by Escherichia coli, with two-thirds of affected infants born preterm. The findings revealed substantial resistance to standard first-line therapies: 95 per cent of isolates were resistant to ampicillin, 87 per cent to cefotaxime, and 85 per cent to gentamicin. Multidrug resistance was documented in 88 per cent of cases. Infants who received ineffective antimicrobial therapy experienced higher all-cause mortality. Low birthweight and late-onset sepsis were identified as significant risk factors for resistance to combined ampicillin and gentamicin. Resistance was comparatively low for amikacin and imipenem, indicating that alternative regimens may be needed, subject to future assessments of local cost, safety, and drug availability.
Newborn sepsis is a major driver of infant mortality globally. Because current World Health Organization first-line antibiotic treatments are rendered ineffective by widespread antimicrobial resistance, standard clinical protocols risk failing vulnerable newborns. Demonstrating the scale of resistance in hospital settings provides urgent evidence for clinicians and health authorities to reassess neonatal care protocols and select therapies that improve infant survival.
The abstract does not indicate a direct commercialisation pathway, as it is observational epidemiological research. The findings primarily serve clinical decision-makers and health system procurers evaluating alternative hospital therapies like amikacin. Additionally, the high prevalence of multidrug-resistant pathogens highlights an applied opportunity for diagnostic developers creating rapid, point-of-care antimicrobial susceptibility tests tailored for neonatal intensive care units.
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INTRODUCTION: Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics. OBJECTIVES: Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis. METHODS: At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression. RESULTS: Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were Klebsiella pneumoniae 94 (79%) followed by Escherichia coli 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics. CONCLUSION: There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.
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DOI: 10.1371/journal.pone.0255410
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