High Burden of Bloodstream Infections Associated with Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India

Background: Antimicrobial resistance (AMR) is a growing threat to newborns in low and middle income countries (LMIC).

Methods: We performed a prospective cohort study in three tertiary Neonatal Intensive Care Units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSI). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early onset BSI was defined as BSI on day of life (DOL) 0-2 and late onset BSI on DOL 3 or later.

Results: From May 1, 2017, until April 30, 2018, 4073 neonates were enrolled. Among at risk neonates, 55 (1.6%) developed early onset BSI and 176 (5.5%) developed late onset BSI. The majority of BSI were caused by Gram-negative bacteria (GNB) (58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n=53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early onset BSI (31% vs. 10%, p<0.001) and late onset BSI (24% vs. 7%, p<0.001). Non-low birth weight neonates with late onset BSI had the greatest excess in mortality, (22% vs. 3%, p<0.001).

Conclusions: In our cohort, neonatal BSI were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.