Neonatal sepsis, defined as a systemic infection occurring within the first 28 days of life, continues to be a major contributor to neonatal mortality in India. National reports estimate that infections account for nearly one-third of neonatal deaths [1]. The epidemiological pattern of neonatal sepsis varies geographically and temporally. Earlier Indian studies such as the National Neonatal-Perinatal Database (NNPD) and the Delhi Neonatal Infection Study (DeNIS) reported predominance of Gram-negative organisms, particularly Klebsiella and Acinetobacter species [1,2]. However, recent institutional data from various tertiary centers indicate a rising prevalence of Gram-positive infections, especially MRSA. Continuous regional surveillance is therefore critical for updating empirical antibiotic policies. The present study aims to determine the incidence, bacteriological spectrum, and antimicrobial susceptibility pattern of neonatal sepsis in a tertiary care hospital in coastal Maharashtra and compare the findings with national datasets.

MATERIALS AND METHODS

Study Design and Setting

Retrospective observational study conducted in the Department of Microbiology and NICU, SSPM Medical College & Lifetime Hospital, Maharashtra.

Study Period

January 2023 – August 2025.

Inclusion Criteria

Neonates (0–28 days) with clinical suspicion of sepsis and positive blood culture.

Exclusion Criteria

Contaminated samples and incomplete records.

Microbiological Processing

Blood cultures were processed under aseptic precautions using Bact/ALERT 3D 60 (Biomerieux, France)  techniques. Organisms were identified and Antimicrobial susceptibility testing was performed using the Fully automated Vitek-2 (Biomerieux, France)  and interpreted according to CLSI guidelines.

Statistical Analysis

Data were analysed using descriptive statistics and expressed as percentages and proportions. Comparative analysis was performed with published national datasets.

RESULTS AND DISCUSSION

Among 205 live births, 44 neonates had culture-proven sepsis, yielding an incidence of 21.46%, comparable to Indian tertiary care reports ranging from 20–30% [1–5].

A total of 44 culture-positive cases were identified, yielding an incidence of 21.46%. Early-onset sepsis predominated (85%). Staphylococcus aureus was the most common isolate. MRSA prevalence was 50%. Emerging carbapenem resistance was noted among Acinetobacter spp.

Table 1: Distribution of Early-Onset and Late-Onset Neonatal Sepsis

Table 2: Bacteriological Profile of Culture-Positive Neonatal Sepsis (n = 44)

Note: Percentages are calculated out of total culture-positive cases.

Table 3: Antibiotic Sensitivity Pattern of Major Isolates

Table 4: Comparison of Incidence with National Studies

Table 5: Comparison of Gram-Positive and Gram-Negative Distribution

The MRSA prevalence of 50% falls within the national range of 30–60% [4–6]. Carbapenem resistance in Acinetobacter spp. (66.7%) aligns with alarming national trends reported in tertiary centers [6,7]. However, preserved Imipenem sensitivity in Klebsiella pneumoniae suggests effective carbapenem stewardship locally.

Clinical Implications

1. Consider MRSA coverage in high-risk early-onset sepsis.
2. Restrict carbapenem use to culture-proven indications.
3. Strengthen NICU infection control measures.
4. Implement annual institutional antibiogram surveillance.

CONCLUSIONS

The study demonstrates a significant burden of early-onset neonatal sepsis with a notable shift toward Gram-positive predominance and substantial MRSA prevalence. Emerging carbapenem resistance in non-fermenting Gram-negative bacilli, particularly Acinetobacter spp., highlights the urgent need for robust antimicrobial stewardship and stringent infection control practices. Periodic surveillance remains essential to guide evidence-based NICU antibiotic policies.

Ethics approval and consent to participate

Institutional Ethics Committee approval was obtained prior to study initiation. Confidentiality of patient data was maintained.

List of Abbreviations

MRSA – Methicillin-Resistant Staphylococcus aureus
NNPD – National Neonatal-Perinatal Database
DeNIS – Delhi Neonatal Infection Study
CLSI – Clinical and Laboratory Standards Institute
NICU – Neonatal Intensive Care Unit

Data Availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of Interest                         

The authors declare that there is no conflict of interest regarding the publication of this paper.

Funding Statement

No external funding was received for this study.

Authors' Contributions

SST conceptualized the study, analysed microbiological data, and drafted the manuscript. VV supervised the study, interpreted findings, and critically revised the manuscript. Both authors read and approved the final manuscript.

Acknowledgments

The authors thank the NICU and laboratory staff for their support.

REFERENCES

1. National Neonatal-Perinatal Database Network, ICMR, 2002.
2. DeNIS Collaboration, Lancet Global Health, 2016.
3. Tallur SS et al., Indian Journal of Pediatrics, 2000.
4. Kumari et al., “Bacteriological profile of neonatal sepsis,” Indian Journal of Pediatrics, vol. 86, pp. 305–310, 2019.
5. Roy et al., “Bacteriology of neonatal septicemia,” Indian Journal of Medical Microbiology, vol. 20, pp. 156–159, 2002.
6. M. Sharma et al., “Neonatal sepsis: Bacteriological profile and antibiotic sensitivity,” Journal of Clinical and Diagnostic Research, vol. 7, pp. 2511–2513, 2013.
7. G. Joshi et al., “Antimicrobial resistance trends in neonatal pathogens,” Indian Journal of Pathology and Microbiology, vol. 43, pp. 39–43, 2000.