Abstract / Summary
We conducted a retrospective before and after comparative observational study using routinely collected hospital data from neonates with suspected sepsis admitted between January 2022 and July 2024. Outcomes were compared with a previous study (2017–2020) following implementation of operational research interventions. The median turnaround time for culture positive results was 2 days (48 h), whereas culture negative reports took five days. A total of 78 cultures demonstrated bacterial growth, including nine contaminants. After exclusion of contaminants, 69 neonates (13.6%) had clinically significant culture positive sepsis. Gram-positive organisms accounted for most isolates (56.5%), primarily coagulase-negative Staphylococci (40.6%) and Staphylococcus aureus (13.0%), whereas gram-negative organisms constituted 43%, dominated by Klebsiella pneumoniae (23.2%) and Escherichia coli (14.5%). Approximately half of the isolates were multidrug resistant, with high levels of penicillin resistance found in several organisms. Late-onset sepsis was responsible for 26.5% ( n = 134) of cases. Notably, 28.9% ( n = 146) of neonates were discharged before culture results were available, with 27 (5.3%) being confirmed as culture positive. Post-culture antibiotic therapy changed in 25.4% ( n = 128) of neonates, including 30.8% of culture-positive cases. Differences in turnaround time were observed compared with the 2017–2020 cohort, although lower culture positivity was observed during the current study period. Mortality remained relatively unchanged at approximately 7% across both study periods. Although culture positivity declined over time, multidrug-resistant organisms remained common, highlighting the continued need for strengthened antimicrobial stewardship, infection prevention measures, and ongoing antimicrobial resistance surveillance.