{
  "abstract": "Background There has been little decline in neonatal mortality rates over recent decades, and this is now further challenged by the rising prevalence of antimicrobial resistance. In Australia, the incidence of neonatal sepsis is low on a global scale, yet there are increasingly frequent outbreaks of multidrug-resistant (MDR) infections in neonatal intensive care units, alongside rising rates of colonisation with MDR bacteria.Methods We analysed positive blood and cerebrospinal fluid cultures collected from infants (aged 0 to ≤180 days) across five clinical sites in Australia between 2010 and 2019, to determine evolving antimicrobial susceptibility profiles.Results After excluding presumed contaminants, we analysed 743 pathogenic bacterial isolates cultured from 624 neonates and infants with early-onset (≤72 hours), late-onset (>72 hours to ≤28 days) and very late-onset (>28 days to ≤180 days) infections. Escherichia coli (37%) and Streptococcus agalactiae (31%) were the primary pathogens responsible for early-onset bloodstream infections, while coagulase-negative staphylococci, E. coli and Staphylococcus aureus were responsible for most infections in older neonates and infants. Antimicrobial susceptibility to currently recommended empiric regimens remains high; however, gram-negative bacteria—including MDR bacteria—were responsible for an increasing proportion of very late-onset infections over the study period (22% in 2010–2014 vs 34% in 2015–2019; p=0.07).Conclusions Although empiric antimicrobial regimens remain adequate for most pathogens causing infections in neonates and infants in Australia, there is an increasing burden of invasive infections caused by gram-negative bacteria. Ongoing surveillance is necessary to ensure empiric antimicrobial guidelines remain efficacious and appropriate.",
  "authors": [
    {
      "affiliations": [
        "Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia",
        "School of Women & Children’s Health, University of New South Wales, Sydney, New South Wales, Australia",
        "Department of Paediatric Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia"
      ],
      "name": "Phoebe C M Williams"
    },
    {
      "affiliations": [
        "Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Mona Mostaghim"
    },
    {
      "affiliations": [
        "Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Jackson Harrison"
    },
    {
      "affiliations": [
        "Department of Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia"
      ],
      "name": "Monica Lahra"
    },
    {
      "affiliations": [
        "Department of Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"
      ],
      "name": "Mark Greenhalgh"
    },
    {
      "affiliations": [
        "Centre for Infectious Diseases and Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia"
      ],
      "name": "Matthew O’Sullivan"
    },
    {
      "affiliations": [
        "Department of Microbiology & Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia"
      ],
      "name": "Michael Maley"
    },
    {
      "affiliations": [
        "Department of Neonatology, The Royal Hospital for Women, Randwick, New South Wales, Australia"
      ],
      "name": "Ju-Lee Oei"
    },
    {
      "affiliations": [
        "Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia",
        "Department of Infectious Diseases, Nepean Hospital, Penrith, New South Wales, Australia"
      ],
      "name": "Archana Koirala"
    },
    {
      "affiliations": [
        "Department of Neonatology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia",
        "NHMRC Clinical Trial Centre, University of Sydney, Sydney, New South Wales, Australia"
      ],
      "name": "Himanshu Popat"
    },
    {
      "affiliations": [
        "Newborn Care, Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of NSW, Sydney, New South Wales, Australia"
      ],
      "name": "Kei Lui"
    },
    {
      "affiliations": [
        "School of Women & Children’s Health, University of New South Wales, Sydney, New South Wales, Australia",
        "Department of Paediatric Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia"
      ],
      "name": "Brendan McMullan"
    },
    {
      "affiliations": [
        "School of Women & Children’s Health, University of New South Wales, Sydney, New South Wales, Australia",
        "Department of Paediatric Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia"
      ],
      "name": "Pamela Palasanthiran"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and MIcrobiology, Sydney Children’s Hospital, Westmead, New South Wales, Australia"
      ],
      "name": "Alison Kesson"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and MIcrobiology, Sydney Children’s Hospital, Westmead, New South Wales, Australia"
      ],
      "name": "David Isaacs"
    },
    {
      "affiliations": [
        "School of Women & Children’s Health, University of New South Wales, Sydney, New South Wales, Australia",
        "Paediatric Infectious Diseases, The Kirby Institute, University of NSW, Sydney, New South Wales, Australia"
      ],
      "name": "Adam William Bartlett"
    }
  ],
  "title": "Epidemiology of early-onset and late-onset invasive infections in Australian neonates and infants: a retrospective multicentre study",
  "uid": "aa448edc-e95e-53d5-960c-c68310f96d37"
}