Microbial Battlefield: Changing Trends of WHO Fungal and Bacterial Priority Pathogens Among Neonates and Their Antimicrobial Resistance from a Tertiary Care Center in South India—An Observational Study

Abstract

Introduction

Sepsis is the leading cause of mortality among neonates, considering which the World Health Organization (WHO) has listed fungal and bacterial priority pathogens (BPP). Reporting microorganisms causing sepsis helps increase awareness among nursing staff and doctors and guides the formulation of preventive steps to combat sepsis as a team in the unit.

Aim

This study describes the distribution and trends of WHO BPP and fungal priority pathogens responsible for neonatal sepsis over 8 years and their antimicrobial resistance.

Methodology

This was a descriptive study done among neonates with positive blood cultures (BACT/ALERT 3D) over 8 years after obtaining ethics approval. Scoring of microorganisms was done according to the WHO category of “the level of treatability.”

Results

A total of 381 cultures were isolated as positive among 277 neonates. One-fourth of isolates were BPP. Median gestational age and birthweight were 29.3 weeks (27-33.5) and 1,100 g (800-1,860), respectively. The BPP identified were carbapenem-resistant (CR) and cephalosporin-resistant Enterobacterales, CR Acinetobacter spp. and Pseudomonas spp., vancomycin-resistant Enterococcus (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). A three-fold increase in Candida sepsis was noted. On the WHO level of treatability scoring, all organisms were classified as “low” (score <5), indicating that they were very difficult to treat, and Klebsiella had the maximum mortality (55%).

Conclusion

A neonatal-specific priority pathogen list would be more beneficial for classification. All BPPs are categorized as very difficult to treat among neonates and cause high mortality compared to non-BPPs. Over the past 8 years, rates of Candida sepsis have increased by three times, especially Candida auris. Among Gram-negative bacilli (GNB), Klebsiella remained the leading pathogen.