Antibiotic strategies for neonatal sepsis: navigating efficacy and emerging resistance patterns.

Neonatal sepsis is a critical global health challenge, resulting in high morbidity and mortality. This systematic review and meta-analysis was designed to evaluate the effectiveness of different treatments with antibiotics on neonatal sepsis, as well as resistance patterns affecting treatment outcomes. PubMed, Scopus, and Web of Science articles from January 2005 to December 2024 were included in the analysis. Studies focused on mortality, treatment failure rates, and pathogen-specific resistance profiles. The review involved data from 37 articles, which included 8954 neonates. Findings were that overall mortality rates associated with neonatal sepsis were between 10 and 30% based on the used antibiotic regimen. Combination therapies have modest survival advantage over single agent therapies. Of grave concern in the resistance trends were the incidence of 20% to 45% among aminoglycoside resistance and that of 15% to 35% to third-generation cephalosporins. Carbapenem-resistant Gram-negative pathogens emerged in an incidence of 10% from various regions in the world.

conclusionThe studies underscored the role of antibiotic stewardship programs and local surveillance in tailoring empirical treatment. Results from this meta-analysis suggest that while combination antibiotic therapies can offer slight survival benefits in the treatment of neonatal sepsis, the rapid escalating resistance rates point to the need for robust stewardship and the continuous updating of treatment guidelines based on local microbial patterns. Future studies should focus on new antibiotics and adjunctive treatment methods to reduce treatment failure and combat the rising antibiotic resistance in neonatal intensive care settings. WHAT IS KNOWN: • Neonatal sepsis remains a significant global health issue, contributing to high morbidity and mortality rates. • The increasing prevalence of multidrug-resistant (MDR) organisms complicates effective antibiotic selection, limiting treatment options. WHAT IS NEW: • This study incorporates data from 37 articles spanning two decades, offering a comprehensive assessment of antibiotic efficacy in neonatal sepsis treatment. • The review highlights specific antibiotic combinations that demonstrate superior outcomes in reducing mortality and treatment failure rates.