{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:56:09Z","timestamp":1787590569693,"version":"build-2736575974"},"reference-count":40,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":104,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"crossref","award":["1197335"],"award-info":[{"award-number":["1197335"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed positive blood and cerebrospinal fluid cultures collected from infants (aged 0 to \u2264180 days) across five clinical sites in Australia between 2010 and 2019, to determine evolving antimicrobial susceptibility profiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After excluding presumed contaminants, we analysed 743 pathogenic bacterial isolates cultured from 624 neonates and infants with early-onset (\u226472\u2009hours), late-onset (&gt;72\u2009hours to \u226428 days) and very late-onset (&gt;28\u2009days to \u2264180 days) infections.\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      (37%) and\n                      <jats:italic>Streptococcus agalactiae<\/jats:italic>\n                      (31%) were the primary pathogens responsible for early-onset bloodstream infections, while coagulase-negative staphylococci,\n                      <jats:italic>E. coli<\/jats:italic>\n                      and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      were responsible for most infections in older neonates and infants. Antimicrobial susceptibility to currently recommended empiric regimens remains high; however, gram-negative bacteria\u2014including MDR bacteria\u2014were responsible for an increasing proportion of very late-onset infections over the study period (22% in 2010\u20132014 vs 34% in 2015\u20132019; p=0.07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-002733","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:45:25Z","timestamp":1760352325000},"page":"e002733","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology of early-onset and late-onset invasive infections in Australian neonates and infants: a retrospective multicentre study"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2250-0594","authenticated-orcid":false,"given":"Phoebe C M","family":"Williams","sequence":"first","affiliation":[{"name":"Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"School of Women & Children\u2019s Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Department of Paediatric Infectious Diseases, Sydney Children\u2019s Hospital Randwick, Randwick, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona","family":"Mostaghim","sequence":"additional","affiliation":[{"name":"Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Harrison","sequence":"additional","affiliation":[{"name":"Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Lahra","sequence":"additional","affiliation":[{"name":"Department of Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Greenhalgh","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Centre for Infectious Diseases and Microbiology, NSW Health Pathology, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Maley","sequence":"additional","affiliation":[{"name":"Department of Microbiology & Infectious Diseases, NSW Health Pathology, Liverpool, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Lee","family":"Oei","sequence":"additional","affiliation":[{"name":"Department of Neonatology, The Royal Hospital for Women, Randwick, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2567-8825","authenticated-orcid":false,"given":"Archana","family":"Koirala","sequence":"additional","affiliation":[{"name":"Sydney Institute for Infectious Diseases, School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Infectious Diseases, Nepean Hospital, Penrith, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6991-9686","authenticated-orcid":false,"given":"Himanshu","family":"Popat","sequence":"additional","affiliation":[{"name":"Department of Neonatology, The Children\u2019s Hospital at Westmead, Westmead, New South Wales, Australia"},{"name":"NHMRC Clinical Trial Centre, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Lui","sequence":"additional","affiliation":[{"name":"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"McMullan","sequence":"additional","affiliation":[{"name":"School of Women & Children\u2019s Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Department of Paediatric Infectious Diseases, Sydney Children\u2019s Hospital Randwick, Randwick, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Palasanthiran","sequence":"additional","affiliation":[{"name":"School of Women & Children\u2019s Health, University of New South Wales, Sydney, New South Wales, Australia"},{"name":"Department of 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