{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:27:59Z","timestamp":1786447679501,"version":"build-2736575974"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antimicrobial drugs are fundamental to modern medicine. The rise and spread of drug-resistant microorganisms jeopardize our ability to manage common infections and perform critical medical interventions. The present work aimed to assess and analyze antimicrobial resistance and sensitivity in the neonatal intensive care unit of Alexandria University Children\u2019s Hospital to improve antibiotic choices in the neonatal intensive care unit. A medical record-based study of 1105 neonates with sepsis admitted to the NICU during the four-year study period (2019 to 2022) was conducted, with no exclusion criteria. The data were uploaded to the WHONET system after being collected. The results can be recorded as interpreted values: \u201cR\u201d (Resistant), \u201cI\u201d (Intermediate), and \u201cS\u201d (Sensitive). Interpretation guidelines for most standardized testing methodologies were built into the system. In addition, the program also permits retrieval and correction of clinical records. Among the 1105 neonates included in our study, Male patients accounted for 56.4%, with a mean gestational age of 32.67\u2009\u00b1\u20092.86 weeks. Early-onset neonatal sepsis (EOS) was detected in 329(29.7%), while late-onset neonatal sepsis (LOS) was detected in 776(70.2%) neonates. Klebsiella was the predominant pathogen, accounting for 554 (50.1%). This organism was responsible for 136(24.5%) neonates in 2019, 148(26.7%) neonates in 2020, 137(24.7%) neonates in 2021 and 133(24.0%) neonates in 2022. Candida species was the second most common pathogen in our NICU; 126 (11.4%) cases were distributed as follows: 31 (24.6%), 32 (25.4%), and 40 (31.7%). 23 (18.2%) cases occurred in 2019, 2020, 2021, and 2022, respectively. Across the 4 years of the study, 2020 had the highest sepsis frequency. Drug resistance was high in most of the isolates. It was maximum (94\u201380%) for Cefotaxime, Piperacillin, Amoxicillin\/Clavulanic acid, and ceftriaxone. It varied between 60 and 80% for Piperacillin\/Tazobactam, Imipenem, Ceftazidime, Cefoperazone\/Sulbactam, Meropenem, Ampicillin\/Sulbactam, and Ciprofloxacin. The current study found that neonatal sepsis had a nosocomial infection profile shared by both early-onset and late-onset sepsis. K. pneumoniae was the predominant pathogen in both EOS and LOS in our study, similar to other developing countries, and is totally different from developed countries.<\/jats:p>","DOI":"10.1038\/s41598-026-65490-9","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:24:31Z","timestamp":1786443871000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surveillance of antimicrobial resistance in neonatal intensive care unit of Alexandria University Children\u2019s Hospital"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7584-8722","authenticated-orcid":false,"given":"Ehsan Akram","family":"Deghidy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Alaa","family":"El-Din Thabet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrine Fathi","family":"Hanafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samah Mohamed","family":"Shehata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwa Mohamed","family":"Farag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"3","key":"65490_CR1","first-page":"645","volume":"3","author":"A Gaballah","year":"2022","unstructured":"Gaballah, A., Shawky, S. & Amer, A. Microbiological profiles of neonatal sepsis in northern Egypt. Microb. Infect. Dis. 3(3), 645\u2013656 (2022).","journal-title":"Microb. Infect. Dis."},{"issue":"1","key":"65490_CR2","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s13756-017-0225-9","volume":"6","author":"L Mohsen","year":"2017","unstructured":"Mohsen, L. et al. Emerging antimicrobial resistance in early and late-onset neonatal sepsis. Antimicrob. Resist. Infect. Control. 6(1), 63 (2017).","journal-title":"Antimicrob. Resist. Infect. Control."},{"issue":"3","key":"65490_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10030323","volume":"10","author":"B Tessema","year":"2021","unstructured":"Tessema, B., Lippmann, N., Kn\u00fcpfer, M., Sack, U. & K\u00f6nig, B. Antibiotic resistance patterns of bacterial isolates from neonatal sepsis patients at University Hospital of Leipzig, Germany. Antibiotics 10(3), 323 (2021).","journal-title":"Antibiotics"},{"issue":"1","key":"65490_CR4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/01.EPX.0000482038.76692.3","volume":"91","author":"HA Awad","year":"2016","unstructured":"Awad, H. A., Mohamed, M. H., Badran, N. F., Mohsen, M. & Abd-Elrhman, A. S. Multidrug-resistant organisms in neonatal sepsis in two tertiary neonatal ICUs, Egypt. J. Egypt. Public Health Assoc. 91(1), 31\u201338 (2016).","journal-title":"J. Egypt. Public Health Assoc."},{"issue":"3","key":"65490_CR5","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/S0377-1237(09)80020-8","volume":"65","author":"A Agarwal","year":"2009","unstructured":"Agarwal, A., Kapila, K. & Kumar, S. WHONET software for the surveillance of antimicrobial susceptibility. Med. J. Armed Forces India 65(3), 264\u2013266 (2009).","journal-title":"Med. J. Armed Forces India"},{"issue":"7","key":"65490_CR6","doi-asserted-by":"publisher","first-page":"186","DOI":"10.20546\/ijcmas.2022.1107.023","volume":"11","author":"V Raman","year":"2022","unstructured":"Raman, V., Sankara, D. & Udayakumar, A. Role of WHONET software beyond antimicrobial resistance in clinical microbiology. Int. J. Curr. Microbiol. App. Sci. 11(7), 186\u2013198 (2022).","journal-title":"Int. J. Curr. Microbiol. App. Sci."},{"issue":"9","key":"65490_CR7","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1080\/14787210.2022.2098115","volume":"20","author":"N Binello","year":"2022","unstructured":"Binello, N. et al. Automated detection of hospital outbreaks of multi-drug resistant pathogens in one Italian region. Expert Rev. Anti Infect. Ther. 20(9), 1233\u20131241 (2022).","journal-title":"Expert Rev. Anti Infect. Ther."},{"issue":"1","key":"65490_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-023-04399-y","volume":"23","author":"M Sherif","year":"2023","unstructured":"Sherif, M., Abera, D. & Desta, K. Prevalence and antibiotic resistance pattern of bacteria from sepsis-suspected neonates at St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Pediatr. 23(1), 575 (2023).","journal-title":"BMC Pediatr."},{"key":"65490_CR9","first-page":"1","volume":"69","author":"K Salama","year":"2021","unstructured":"Salama, K., Gad, A. & El Tatawy, S. Sepsis profile and outcome of preterm neonates admitted to neonatal intensive care unit of Cairo University Hospital. Egypt Pediatr Assoc Gazette. 69, 1\u20139 (2021).","journal-title":"Egypt Pediatr Assoc Gazette."},{"issue":"1","key":"65490_CR10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.21608\/scvmj.2023.307329","volume":"28","author":"M Abdel-Razik","year":"2023","unstructured":"Abdel-Razik, M., Hafez, E. A. & Hassan, M. A. Prevalence of bacterial infections in neonatal intensive care unit and genetic characterization of their drug resistance. Suez Canal Veterinary Medical Journal. SCVMJ 28(1), 33\u201344 (2023).","journal-title":"Suez Canal Veterinary Medical Journal. SCVMJ"},{"issue":"1","key":"65490_CR11","first-page":"77","volume":"12","author":"PP Shah","year":"2023","unstructured":"Shah, P. P., Shah, P. & Shah, S. Assessment of neonatal outcome of the patients admitted in NICU. Int. J. Life Sci. Biotechnol. Pharm. Res. 12(1), 77\u201380 (2023).","journal-title":"Int. J. Life Sci. Biotechnol. Pharm. Res."},{"issue":"1","key":"65490_CR12","first-page":"18","volume":"35","author":"Y Zenebe","year":"2021","unstructured":"Zenebe, Y., Molla, T., Beza, L. & Mekonnen, D. Bacterial profile and antimicrobial susceptibility pattern of neonatal sepsis in Felege-Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia: A cross-sectional study design. Ethiop J Health Dev. 35(1), 18\u201328 (2021).","journal-title":"Ethiop J Health Dev."},{"issue":"3","key":"65490_CR13","doi-asserted-by":"publisher","first-page":"493","DOI":"10.4103\/jfmpc.jfmpc_1535_22","volume":"12","author":"T Siddiqui","year":"2023","unstructured":"Siddiqui, T. et al. Bacteriological profiles and antibiotic susceptibility of neonatal sepsis in a university hospital of Northern India. J. Fam. Med. Prim. Care 12(3), 493\u2013498 (2023).","journal-title":"J. Fam. Med. Prim. Care"},{"issue":"6","key":"65490_CR14","doi-asserted-by":"publisher","first-page":"100971","DOI":"10.1016\/j.disamonth.2020.100971","volume":"66","author":"MA Abushaheen","year":"2020","unstructured":"Abushaheen, M. A. et al. Antimicrobial resistance, mechanisms and its clinical significance. Dis Mon. 66(6), 100971 (2020).","journal-title":"Dis Mon."},{"issue":"232","key":"65490_CR15","first-page":"976","volume":"58","author":"BR Pandit","year":"2020","unstructured":"Pandit, B. R. & Vyas, A. Clinical symptoms, pathogen spectrum, risk factors and antibiogram of suspected neonatal sepsis cases in tertiary care hospital of southern part of Nepal: A descriptive cross-sectional study. JNMA J. Nepal Med. Assoc. 58(232), 976\u2013982 (2020).","journal-title":"JNMA J. Nepal Med. Assoc."},{"issue":"1","key":"65490_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-024-04639-9","volume":"24","author":"S Miranda","year":"2024","unstructured":"Miranda, S., Harahap, A., Husada, D. & Faramarisa, F. N. Risk factors of multidrug-resistant organisms neonatal sepsis in Surabaya tertiary referral hospital: A single-center study. BMC Pediatr. 24(1), 153 (2024).","journal-title":"BMC Pediatr."},{"key":"65490_CR17","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.jpeds.2021.08.067","volume":"239","author":"S Jiang","year":"2021","unstructured":"Jiang, S. et al. Antibiotic use in neonatal intensive care units in China: A multicenter cohort study. J. Pediatr. 239, 136\u2013142 (2021).","journal-title":"J. Pediatr."},{"issue":"1","key":"65490_CR18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0244866","volume":"16","author":"M Atif","year":"2021","unstructured":"Atif, M., Zia, R., Malik, I., Ahmad, N. & Sarwar, S. Treatment outcomes, antibiotic use and its resistance pattern among neonatal sepsis patients attending Bahawal Victoria Hospital, Pakistan. PLoS ONE 16(1), e0244866 (2021).","journal-title":"PLoS ONE"},{"key":"65490_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-020-4875-5","volume":"20","author":"D Husada","year":"2020","unstructured":"Husada, D. et al. Predictive model for bacterial late-onset neonatal sepsis in a tertiary care hospital in Thailand. BMC Infect. Dis. 20, 1\u201311 (2020).","journal-title":"BMC Infect. Dis."},{"issue":"1","key":"65490_CR20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.21608\/ejmm.2020.249877","volume":"29","author":"IH Draz","year":"2020","unstructured":"Draz, I. H., Dwedar, R. A., Hagag, S. & Salama, N. Prevalence and prognosis of thrombocytopenia in blood culture proven neonatal sepsis. Egypt. J. Med. Microbiol. 29(1), 181\u2013186 (2020).","journal-title":"Egypt. J. Med. Microbiol."},{"key":"65490_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2021.111968","volume":"204","author":"N Dey","year":"2022","unstructured":"Dey, N. et al. Role of nanomaterials in deactivating multiple drug resistance efflux pumps\u2014A review. Environ. Res. 204, 111968 (2022).","journal-title":"Environ. Res."},{"issue":"1","key":"65490_CR22","first-page":"39","volume":"15","author":"MN Almohammady","year":"2020","unstructured":"Almohammady, M. N., Eltahlawy, E. M. & Reda, N. M. Pattern of bacterial profile and antibiotic susceptibility among neonatal sepsis cases at Cairo University Children Hospital. J. Taibah Univ. Med. Sci. 15(1), 39\u201347 (2020).","journal-title":"J. Taibah Univ. Med. Sci."},{"issue":"2","key":"65490_CR23","doi-asserted-by":"publisher","first-page":"3798","DOI":"10.21608\/ejhm.2021.204578","volume":"85","author":"TH Atteyah","year":"2021","unstructured":"Atteyah, T. H., Mokhtar, W. A. E. M., Malek, M. M. & Mohammed, A. B. Detection of bacteria causing early onset pneumonia among neonates admitted to NICU in Children Hospital, Zagazig University. Egypt. J. Hosp. Med. 85(2), 3798\u20133804 (2021).","journal-title":"Egypt. J. Hosp. Med."},{"issue":"5","key":"65490_CR24","first-page":"11","volume":"11","author":"G Govindaraju","year":"2020","unstructured":"Govindaraju, G., Arumugam, V., Mageswari, T., Rajaiah, B. & Ramakrishnan, S. Sepsis in neonates: prevalence of microorganisms and their susceptibility pattern in neonatal intensive care unit of a tertiary care hospital\u2014A retrospective study. J. Basic Clin. Pharm. 11(5), 11\u201316 (2020).","journal-title":"J. Basic Clin. Pharm."},{"issue":"1","key":"65490_CR25","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1038\/s41390-020-01248-x","volume":"90","author":"GM Froeschle","year":"2021","unstructured":"Froeschle, G. M. et al. T cell cytokines in the diagnosis of early-onset sepsis. Pediatr Res. 90(1), 191\u2013196 (2021).","journal-title":"Pediatr Res."},{"issue":"2","key":"65490_CR26","first-page":"31","volume":"32","author":"RM Raafat Hamed","year":"2023","unstructured":"Raafat Hamed, R. M. et al. Alarming antibiotic resistance pattern of bacterial isolates in neonatal sepsis: A study from Egypt. Egypt J. Med. Microbiol. 32(2), 31\u201339 (2023).","journal-title":"Egypt J. Med. Microbiol."},{"issue":"16","key":"65490_CR27","doi-asserted-by":"publisher","first-page":"2655","DOI":"10.1080\/14767058.2019.1670799","volume":"34","author":"M Lamba","year":"2021","unstructured":"Lamba, M., Sharma, D., Sharma, R., Vyas, A. & Mamoria, V. To study the profile of Candida isolates and antifungal susceptibility pattern of neonatal sepsis in a tertiary care hospital of North India. J. Matern. Fetal Neonatal Med. 34(16), 2655\u20132659 (2021).","journal-title":"J. Matern. Fetal Neonatal Med."},{"issue":"4","key":"65490_CR28","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics12040767","volume":"12","author":"M Majigo","year":"2023","unstructured":"Majigo, M. et al. Bacterial etiology of neonatal sepsis and antimicrobial resistance pattern at the regional referral hospital, Dar es Salam, Tanzania; A call to strengthening antibiotic stewardship program. Antibiotics 12(4), 767 (2023).","journal-title":"Antibiotics"},{"issue":"1","key":"65490_CR29","volume":"14","author":"AS Alharbi","year":"2022","unstructured":"Alharbi, A. S. Common bacterial isolates associated with neonatal sepsis and their antimicrobial profile: A retrospective study at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Cureus 14(1), e21107 (2022).","journal-title":"Cureus"},{"key":"65490_CR30","doi-asserted-by":"publisher","first-page":"107","DOI":"10.2147\/PHMT.S228241","volume":"10","author":"HT Amare","year":"2019","unstructured":"Amare, H. T. & Amare, A. T. Etiology, clinical features, and short-term outcome of seizures in newborns admitted to the University of Gondar Hospital, Ethiopia. Pediatr. Health Med. Ther. 10, 107\u2013113 (2019).","journal-title":"Pediatr. Health Med. Ther."},{"issue":"3","key":"65490_CR31","first-page":"333","volume":"29","author":"A Sorsa","year":"2019","unstructured":"Sorsa, A. Epidemiology of neonatal sepsis and associated factors implicated: observational study at neonatal intensive care unit of Arsi university teaching and referral hospital, south east Ethiopia. Ethiop. J. Health Sci. 29(3), 333\u2013342 (2019).","journal-title":"Ethiop. J. Health Sci."},{"key":"65490_CR32","doi-asserted-by":"publisher","unstructured":"Distribution of antimicrobial resistance genes and virulence genes in different genotypes of Acinetobacter baumannii. BMC Infect. Dis. 25(1),1230. (2025). https:\/\/doi.org\/10.1186\/s12879-025-11632-9.","DOI":"10.1186\/s12879-025-11632-9"},{"issue":"3","key":"65490_CR33","doi-asserted-by":"publisher","first-page":"323","DOI":"10.3390\/antibiotics10030323","volume":"10","author":"B Tessema","year":"2021","unstructured":"Tessema, B., Lippmann, N., Kn\u00fcpfer, M., Sack, U. & K\u00f6nig, B. Antibiotic resistance patterns of bacterial isolates from neonatal sepsis patients at the University Hospital of Leipzig, Germany. Antibiotics 10(3), 323 (2021).","journal-title":"Antibiotics"},{"key":"65490_CR34","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2023.1135614","volume":"14","author":"A Algammal","year":"2023","unstructured":"Algammal, A., Hetta, H. F., Mabrok, M. & Behzadi, P. Editorial: Emerging multidrug-resistant bacterial pathogens \u201csuperbugs\u201d: A rising public health threat. Front. Microbiol. 14, 1135614 (2023).","journal-title":"Front. Microbiol."},{"key":"65490_CR35","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.975616","volume":"13","author":"P Behzadi","year":"2022","unstructured":"Behzadi, P. et al. Editorial: Current perspectives on Pseudomonas aeruginosa: Epidemiology, virulence and contemporary strategies to combat multidrug-resistant (MDR) pathogens. Front. Microbiol. 13, 975616 (2022).","journal-title":"Front. Microbiol."},{"issue":"11","key":"65490_CR36","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1093\/aje\/kwp334","volume":"170","author":"S Rose","year":"2009","unstructured":"Rose, S. International ethical guidelines for epidemiological studies: By the council for international organizations of medical sciences (CIOMS). Am. J. Epidemiol. 170(11), 1451\u20131452 (2009).","journal-title":"Am. J. Epidemiol."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-65490-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-65490-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-65490-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:29:37Z","timestamp":1786444177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-65490-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["65490"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-65490-9","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]},"assertion":[{"value":"26 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study used existing retrospective data from electronic records and did not involve direct interaction with human participants or the collection of new data. The identifiable\/private information was used solely for research purposes under the approval by the Research Ethics Committee of the Faculty of Medicine, Alexandria University, Egypt (IRB No.: 00012098). The study was conducted in accordance with the Declaration of Helsinki and other international ethical guidelines\n                      35,36\n                      . Informed consent was obtained from the administrator of Alexandria University Children\u2019s Hospital and from the Head of the NICU unit before accessing the electronic records of patients. All the records of neonates who suffered from sepsis and were admitted to the NICU during the four-years-study period [1105 participants] were enrolled in this study, and there were no exclusion criteria.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"24917"}}