Antimicrobial Resistance and Infant Mortality in Sri Lanka: A Retrospective Cohort Study.

Sepsis is a major cause of mortality among children, with the highest burden evident in neonates and young infants, particularly, in resource-constrained healthcare settings. Despite this burden, there are insufficient published data to delineate the epidemiology of neonatal sepsis from many of these settings. We aimed to address this research gap by evaluating the epidemiology of sepsis in neonates and young infants in Sri Lanka, a populous country in Southeast Asia, and to evaluate the efficacy of currently-recommended empiric antibiotic regimens to treat these infections in the context of evolving antimicrobial resistance. We evaluated the pathogens (including susceptibility profiles) responsible for infections in neonates and young infants over a 7-year period alongside clinical outcomes (2015-2021). A 1100 bed urban tertiary hospital in Colombo, Sri Lanka. Neonates and young infants (aged 0 to ≤ 180 days). Blood culture-positive pathogen profiles, antibiotic susceptibility against empiric antibiotic regimens and mortality. We identified 231 neonates and young infants with clinically significant blood cultures incorporating 251 pathogens over the study period, of whom 22 died. Where gestational data were available, most babies with culture-positive sepsis were premature (71%, 65/91), born at a median gestational age of 32 weeks (interquartile range [IQR] 27-38 weeks). Gram-negative bacteria predominated as a cause of culture-positive infections (66%, 166/251), including in 86% of neonates and young infants who died (19/22). There were high rates of non-susceptibility to first- and second-line antibiotics currently recommended to treat neonatal sepsis. There is a high burden of antibiotic-resistant gram-negative infections in neonates and young infants in Sri Lanka, highlighting an urgent need to prioritise the development of new antimicrobial regimens to treat neonatal infections.