{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:03:38Z","timestamp":1791291818692,"version":"4.1.0"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T00:00:00Z","timestamp":1623196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T00:00:00Z","timestamp":1623196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Sepsis is an overwhelming and life-threatening response to bacteria in bloodstream and a major cause of neonatal morbidity and mortality. Understanding the etiology and potential risk factors for neonatal sepsis is urgently required, particularly in low-income countries where burden of infection is high and its epidemiology is poorly understood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A prospective observational cohort study was conducted between April 2016 and October 2017 in a level three NICU at a tertiary care hospital in Nepal to determine the bacterial etiology and potential risk factors for neonatal sepsis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 142 NICU admitted neonates, 15% (21\/142) and 32% (46\/142) developed blood culture-positive and -negative neonatal sepsis respectively. <jats:italic>Klebsiella pneumoniae<\/jats:italic> (34%, 15\/44) and <jats:italic>Enterobacter<\/jats:italic> spp. (25%, 11\/44) were the most common isolates. The antimicrobial resistance of isolates to ampicillin (100%, 43\/43), cefotaxime (74%, 31\/42) and ampicillin-sulbactam (55%, 21\/38) were the highest. <jats:italic>Bla<\/jats:italic><jats:sub>TEM<\/jats:sub> (53%, 18\/34) and <jats:italic>bla<\/jats:italic><jats:sub>KPC<\/jats:sub> (46%, 13\/28) were the commonest ESBL and carbapenemase genes respectively. In univariate logistic regression, the odds of sepsis increased with each additional day of use of invasive procedures such as mechanical ventilation (OR 1.086, 95% CI 1.008\u20131.170), umbilical artery catheter (OR 1.375, 95% CI 1.049\u20131.803), intravenous cannula (OR 1.140, 95% CI 1.062\u20131.225); blood transfusion events (OR 3.084, 95% CI 1.407\u20136.760); NICU stay (OR 1.109, 95% CI 1.040\u20131.182) and failure to breast feed (OR 1.130, 95% CI 1.060\u20131.205). Sepsis odds also increased with leukopenia (OR 1.790, 95% CI 1.04\u20133.082), increase in C-reactive protein (OR 1.028, 95% CI 1.016\u20131.040) and decrease in platelets count (OR 0.992, 95% CI 0.989\u20130.994). In multivariate analysis, increase in IV cannula insertion days (OR 1.147, 95% CI 1.039\u20131.267) and CRP level (OR 1.028, 95% CI 1.008\u20131.049) increased the odds of sepsis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our study indicated various nosocomial risk factors and underscored the need to improve local infection control measures so as to reduce the existing burden of sepsis. We have highlighted certain sepsis associated laboratory parameters along with identification of antimicrobial resistance genes, which can guide for early and better therapeutic management of sepsis. These findings could be extrapolated to other low-income settings within the region.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06261-x","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T15:04:10Z","timestamp":1623251050000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal"],"prefix":"10.1186","volume":"21","author":[{"given":"Sulochana","family":"Manandhar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja","family":"Amatya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Ansari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niva","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhukesh","family":"Maharjan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Dongol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buddha","family":"Basnyat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer M.","family":"Dixit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Baker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhilasha","family":"Karkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,9]]},"reference":[{"key":"6261_CR1","doi-asserted-by":"publisher","first-page":"319","DOI":"10.2147\/CLEP.S35693","volume":"4","author":"MO Wiens","year":"2012","unstructured":"Wiens MO, Kumbakumba E, Kissoon N, Ansermino JM, Ndamira A, Larson CP. Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol. 2012;4:319\u201325. https:\/\/doi.org\/10.2147\/CLEP.S35693.","journal-title":"Clin Epidemiol"},{"issue":"9465","key":"6261_CR2","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1016\/S0140-6736(05)71881-X","volume":"365","author":"AKM Zaidi","year":"2005","unstructured":"Zaidi AKM, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365(9465):1175\u201388. https:\/\/doi.org\/10.1016\/S0140-6736(05)71881-X.","journal-title":"Lancet."},{"key":"6261_CR3","unstructured":"United Nations. Interagency Group for Child Mortality Estimation. Levels & Trends in Child Mortality: Report 2010: Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation [Internet]. UNICEF. New York; 2019 [cited 2020 Jan 3]. https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/UN-IGME-Child-Mortality-Report-2019.pdf."},{"key":"6261_CR4","unstructured":"United Nations Children\u2019s Fund. Maternal and Newborn Health Disparities: Nepal [Internet]. UNICEF. New York; 2018 [cited 2020 Jan 6]. https:\/\/data.unicef.org\/resources\/maternal-newborn-health-disparities-country-profiles\/Nepal"},{"issue":"4","key":"6261_CR5","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jhin.2005.03.014","volume":"61","author":"WC van der Zwet","year":"2005","unstructured":"van der Zwet WC, Kaiser AM, van Elburg RM, Berkhof J, Fetter WPF, Parlevliet GA, et al. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates. J Hosp Infect. 2005;61(4):300\u201311. https:\/\/doi.org\/10.1016\/j.jhin.2005.03.014.","journal-title":"J Hosp Infect"},{"key":"6261_CR6","first-page":"11","volume":"9","author":"N Christina","year":"2015","unstructured":"Christina N, Ioanna P, George L, Konstantinos T, Georgios S. Risk factors for nosocomial infections in neonatal intensive care units (NICU). Heal Sci J. 2015;9:11\u20134.","journal-title":"Heal Sci J"},{"key":"6261_CR7","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/S0140-6736(08)60106-3","volume":"371","author":"The young infants clinical signs study group","year":"2008","unstructured":"The young infants clinical signs study group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet. 2008;371:135\u201342.","journal-title":"Lancet."},{"issue":"4","key":"6261_CR8","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1038\/sj.jp.7211916","volume":"28","author":"N Schmutz","year":"2008","unstructured":"Schmutz N, Henry E, Jopling J, Christensen RD. Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol. 2008;28(4):275\u201381. https:\/\/doi.org\/10.1038\/sj.jp.7211916.","journal-title":"J Perinatol"},{"issue":"4_ts","key":"6261_CR9","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1093\/ajcp\/45.4_ts.493","volume":"45","author":"A Bauer","year":"1966","unstructured":"Bauer A, Kirby W, Sherris J, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45(4_ts):493\u20136. https:\/\/doi.org\/10.1093\/ajcp\/45.4_ts.493.","journal-title":"Am J Clin Pathol"},{"key":"6261_CR10","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"CLSI","year":"2017","unstructured":"CLSI. Performance standards for antimicrobial susceptibility testing. 2017."},{"issue":"9","key":"6261_CR11","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1128\/AAC.36.9.1877","volume":"36","author":"KS Thomson","year":"1992","unstructured":"Thomson KS, Sanders CC. Detection of extended-spectrum \u03b2-lactamases in members of the family Enterobacteriaceae: comparison of the double-disk and three-dimensional tests. Antimicrob Agents Chemother. 1992;36(9):1877\u201382. https:\/\/doi.org\/10.1128\/AAC.36.9.1877.","journal-title":"Antimicrob Agents Chemother"},{"issue":"1","key":"6261_CR12","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1093\/jac\/dki412","volume":"57","author":"N Woodford","year":"2006","unstructured":"Woodford N, Fagan EJ, Ellington MJ. Multiplex PCR for rapid detection of genes encoding CTX-M extended-spectrum \u03b2-lactamases. J Antimicrob Chemother. 2006;57(1):154\u20135. https:\/\/doi.org\/10.1093\/jac\/dki412.","journal-title":"J Antimicrob Chemother"},{"key":"6261_CR13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1016\/j.jiph.2017.09.020","volume":"11","author":"LW Juan","year":"2018","unstructured":"Juan LW, Hying L, Duan GC, Xin ZY, Yin CS, Yang HY, et al. Emergence and mechanism of carbapenem-resistant Escherichia coli in Henan, China, 2014. J Infect Public Health. 2018;11:347\u201351.","journal-title":"J Infect Public Health"},{"issue":"3","key":"6261_CR14","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1093\/jac\/dkp498","volume":"65","author":"C Dallenne","year":"2010","unstructured":"Dallenne C, da Costa A, Decr\u00e9 D, Favier C, Arlet G. Development of a set of multiplex PCR assays for the detection of genes encoding important \u03b2-lactamases in Enterobacteriaceae. J Antimicrob Chemother. 2010;65(3):490\u20135. https:\/\/doi.org\/10.1093\/jac\/dkp498.","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"6261_CR15","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.diagmicrobio.2010.12.002","volume":"70","author":"L Poirel","year":"2011","unstructured":"Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis. 2011;70(1):119\u201323. https:\/\/doi.org\/10.1016\/j.diagmicrobio.2010.12.002.","journal-title":"Diagn Microbiol Infect Dis"},{"issue":"2","key":"6261_CR16","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1128\/JCM.01773-10","volume":"49","author":"P Nordmann","year":"2011","unstructured":"Nordmann P, Poirel L, Carr\u00ebr A, Toleman MA, Walsh TR. How to detect NDM-1 producers. J Clin Microbiol. 2011;49(2):718\u201321. https:\/\/doi.org\/10.1128\/JCM.01773-10.","journal-title":"J Clin Microbiol"},{"issue":"4","key":"6261_CR17","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.ijantimicag.2006.01.004","volume":"27","author":"N Woodford","year":"2006","unstructured":"Woodford N, Ellington MJ, Coelho JM, Turton JF, Ward ME, Brown S, et al. Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents. 2006;27(4):351\u20133. https:\/\/doi.org\/10.1016\/j.ijantimicag.2006.01.004.","journal-title":"Int J Antimicrob Agents"},{"key":"6261_CR18","doi-asserted-by":"publisher","first-page":"e752","DOI":"10.1016\/S2214-109X(16)30148-6","volume":"4","author":"DeNIS","year":"2016","unstructured":"DeNIS. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Heal. 2016;4:e752\u201360.","journal-title":"Lancet Glob Heal"},{"key":"6261_CR19","first-page":"866","volume":"19","author":"O Ullah","year":"2016","unstructured":"Ullah O, Khan A, Ambreen, Ahmad I, Akhtar T, Gandapor AJ, et al. Antibiotic sensitivity pattern of bacterial isolates of neonatal septicemia in Peshawar, Pakistan. Arch Iran Med. 2016;19:866\u20139.","journal-title":"Arch Iran Med"},{"key":"6261_CR20","doi-asserted-by":"publisher","first-page":"379806","DOI":"10.1155\/2015\/379806","volume":"2015","author":"S Ansari","year":"2015","unstructured":"Ansari S, Nepal HP, Gautam R, Shrestha S, Neopane P, Chapagain ML. Neonatal septicemia in Nepal: early-onset versus late-onset. Int J Pediatr. 2015;2015:379806.","journal-title":"Int J Pediatr"},{"key":"6261_CR21","first-page":"1511","volume":"4","author":"GS Shah","year":"2013","unstructured":"Shah GS, Yadav S, Thapa ASL. Clinical profile and outcome of neonates admitted to neonatal intensive care unit (NICU) at a tertiary Care Centre in Eastern Nepal. J Nepal Paediatr Soc. 2013;4:1511\u20136.","journal-title":"J Nepal Paediatr Soc"},{"key":"6261_CR22","doi-asserted-by":"publisher","first-page":"265","DOI":"10.4103\/0019-5359.99605","volume":"64","author":"F Monjur","year":"2010","unstructured":"Monjur F, Rizwan F, Asaduzzaman M, Nasrin N, Krishna Ghosh N, Sarker Apu A, et al. Antibiotic sensitivity pattern of causative organisms of neonatal septicemia in an urban hospital of Bangladesh. Indian J Med Sci. 2010;64:265.","journal-title":"Indian J Med Sci"},{"key":"6261_CR23","doi-asserted-by":"publisher","first-page":"F249","DOI":"10.1136\/archdischild-2012-301767","volume":"98","author":"A Al-Taiar","year":"2012","unstructured":"Al-Taiar A, Hammoud MS, Cuiqing L, Lee JKF, Lui KM, Nakwan N, et al. Neonatal infections in China, Malaysia, Hong Kong and Thailand. Arch Dis Child Fetal Neonatal Ed. 2012;98:F249\u201355.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"6261_CR24","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1136\/adc.2008.139865","volume":"94","author":"R Tiskumara","year":"2009","unstructured":"Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, et al. Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed. 2009;94:144\u20139.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"6261_CR25","first-page":"15","volume":"10","author":"A Hafsa","year":"2011","unstructured":"Hafsa A, Fakruddin M, Hakim M, Sharma J. Neonatal bacteremia in a neonatal intensive care unit : analysis of causative organisms and antimicrobial susceptibility. Bangladesh J Med Sci. 2011;10:15\u201320.","journal-title":"Bangladesh J Med Sci"},{"issue":"4","key":"6261_CR26","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s12098-010-0272-1","volume":"78","author":"R Viswanathan","year":"2011","unstructured":"Viswanathan R, Singh AK, Mukherjee S, Mukherjee R, Das P, Basu S. Aetiology and antimicrobial resistance of neonatal Sepsis at a tertiary Care Centre in Eastern India: a 3 year study. Indian J Pediatr. 2011;78(4):409\u201312. https:\/\/doi.org\/10.1007\/s12098-010-0272-1.","journal-title":"Indian J Pediatr"},{"key":"6261_CR27","doi-asserted-by":"publisher","first-page":"k5314","DOI":"10.1136\/bmj.k5314","volume":"364","author":"S Chaurasia","year":"2019","unstructured":"Chaurasia S, Sivanandan S, Agarwal R, Ellis S, Sharland M, Sankar MJ. Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance. BMJ. 2019;364:k5314.","journal-title":"BMJ."},{"issue":"3","key":"6261_CR28","doi-asserted-by":"publisher","first-page":"227","DOI":"10.15252\/emmm.201404767","volume":"7","author":"H Chung The","year":"2015","unstructured":"Chung The H, Karkey A, Pham Thanh D, Boinett CJ, Cain AK, Ellington M, et al. A high-resolution genomic analysis of multidrug-resistant hospital outbreaks of Klebsiella pneumoniae. EMBO Mol Med. 2015;7(3):227\u201339. https:\/\/doi.org\/10.15252\/emmm.201404767.","journal-title":"EMBO Mol Med"},{"key":"6261_CR29","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3126\/jpahs.v1i1.13011","volume":"1","author":"P Amatya","year":"2014","unstructured":"Amatya P, Joshi S, Shrestha S. Outbreak of neonatal sepsis outbreak of extended spectrum beta lactamase producing klebsiella species causing neonatal sepsis at Patan hospital in Nepal. J Patan Acad Health Sci. 2014;1:20\u20135.","journal-title":"J Patan Acad Health Sci"},{"issue":"6","key":"6261_CR30","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1097\/QCO.0b013e32833f0d3e","volume":"23","author":"J Ho","year":"2010","unstructured":"Ho J, Tambyah PA, Paterson DL. Multiresistant gram-negative infections: a global perspective. Curr Opin Infect Dis. 2010;23(6):546\u201353. https:\/\/doi.org\/10.1097\/QCO.0b013e32833f0d3e.","journal-title":"Curr Opin Infect Dis"},{"key":"6261_CR31","doi-asserted-by":"publisher","first-page":"F141 LP","DOI":"10.1136\/adc.2007.120709","volume":"97","author":"AB Russell","year":"2012","unstructured":"Russell AB, Sharland M, Heath PT. Improving antibiotic prescribing in neonatal units: time to act. Arch Dis Child - Fetal Neonatal Ed. 2012;97:F141 LP\u2013F146.","journal-title":"Arch Dis Child - Fetal Neonatal Ed"},{"issue":"3","key":"6261_CR32","doi-asserted-by":"publisher","first-page":"F220","DOI":"10.1136\/adc.2002.022863","volume":"90","author":"S Vergnano","year":"2005","unstructured":"Vergnano S. Neonatal sepsis: an international perspective. Arch Dis Child - Fetal Neonatal Ed. 2005;90(3):F220\u2013f224. https:\/\/doi.org\/10.1136\/adc.2002.022863.","journal-title":"Arch Dis Child - Fetal Neonatal Ed"},{"issue":"1","key":"6261_CR33","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4103\/ijmr.IJMR_1288_16","volume":"147","author":"U Devi","year":"2018","unstructured":"Devi U, Bora R, Das JK, Mahanta J. Extended-spectrum \u03b2-lactamase & carbapenemase-producing gram-negative bacilli in neonates from a tertiary care Centre in Dibrugarh, Assam, India. Indian J Med Res. 2018;147(1):110\u20134. https:\/\/doi.org\/10.4103\/ijmr.IJMR_1288_16.","journal-title":"Indian J Med Res"},{"key":"6261_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-016-1935-y","volume":"16","author":"S Breurec","year":"2016","unstructured":"Breurec S, Bouchiat C, Sire JM, Moquet O, Bercion R, Cisse MF, et al. High third-generation cephalosporin resistant Enterobacteriaceae prevalence rate among neonatal infections in Dakar, Senegal. BMC Infect Dis. 2016;16:1\u20137.","journal-title":"BMC Infect Dis"},{"issue":"08","key":"6261_CR35","doi-asserted-by":"publisher","first-page":"942","DOI":"10.3855\/jidc.4590","volume":"8","author":"EN Berezin","year":"2014","unstructured":"Berezin EN, Sol\u00f3rzano F. Gram-negative infections in pediatric and neonatal intensive care units of Latin America. J Infect Dev Ctries. 2014;8(08):942\u201353. https:\/\/doi.org\/10.3855\/jidc.4590.","journal-title":"J Infect Dev Ctries"},{"key":"6261_CR36","first-page":"791","volume":"137","author":"S Roy","year":"2013","unstructured":"Roy S, Gaind R, Chellani H, Mohanty S, Datta S, Singh AK, et al. Neonatal septicaemia caused by diverse clones of Klebsiella pneumoniae & Escherichia coli harbouring blaCTX-M-15. Indian J Med Res. 2013;137:791.","journal-title":"Indian J Med Res"},{"issue":"11","key":"6261_CR37","doi-asserted-by":"publisher","first-page":"e112101","DOI":"10.1371\/journal.pone.0112101","volume":"9","author":"S Datta","year":"2014","unstructured":"Datta S, Roy S, Chatterjee S, Saha A, Sen B, Pal T, et al. A five-year experience of Carbapenem resistance in Enterobacteriaceae causing neonatal Septicaemia: predominance of NDM-1. PLoS One. 2014;9(11):e112101. https:\/\/doi.org\/10.1371\/journal.pone.0112101.","journal-title":"PLoS One"},{"issue":"7","key":"6261_CR38","doi-asserted-by":"publisher","first-page":"e293","DOI":"10.1111\/apa.12256","volume":"102","author":"DF Yumani","year":"2013","unstructured":"Yumani DF, van den Dungen FA, van Weissenbruch MM. Incidence and risk factors for catheter-associated bloodstream infections in neonatal intensive care. Acta Paediatr. 2013;102(7):e293\u20138. https:\/\/doi.org\/10.1111\/apa.12256.","journal-title":"Acta Paediatr"},{"issue":"3","key":"6261_CR39","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1093\/tropej\/fmq060","volume":"57","author":"H Yapicioglu","year":"2011","unstructured":"Yapicioglu H, Ozcan K, Sertdemir Y, Mutlu B, Satar M, Narli N, et al. Healthcare-associated infections in a neonatal intensive care unit in Turkey in 2008: incidence and risk factors, a prospective study. J Trop Pediatr. 2011;57(3):157\u201364. https:\/\/doi.org\/10.1093\/tropej\/fmq060.","journal-title":"J Trop Pediatr"},{"key":"6261_CR40","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3390\/diseases6010014","volume":"6","author":"M Dhaneria","year":"2018","unstructured":"Dhaneria M, Jain S, Singh P, Mathur A, Lundborg C, Pathak A. Incidence and determinants of health care-associated blood stream infection at a neonatal intensive care unit in Ujjain, India: a prospective cohort study. Diseases. 2018;6:14.","journal-title":"Diseases"},{"key":"6261_CR41","doi-asserted-by":"publisher","first-page":"488 LP","DOI":"10.1136\/adc.66.4.488","volume":"66","author":"RN Ashraf","year":"1991","unstructured":"Ashraf RN, Jalil F, Zaman S, Karlberg J, Khan SR, Lindblad BS, et al. Breast feeding and protection against neonatal sepsis in a high risk population. Arch Dis Child. 1991;66:488 LP\u2013490.","journal-title":"Arch Dis Child"},{"key":"6261_CR42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40748-016-0040-y","volume":"3","author":"J Ramasethu","year":"2017","unstructured":"Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Heal Neonatol Perinatol. 2017;3:1\u201311.","journal-title":"Matern Heal Neonatol Perinatol"},{"issue":"4","key":"6261_CR43","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.molmed.2016.02.001","volume":"22","author":"B Kan","year":"2016","unstructured":"Kan B, Razzaghian HR, Lavoie PM. An immunological perspective on neonatal Sepsis. Trends Mol Med. 2016;22(4):290\u2013302. https:\/\/doi.org\/10.1016\/j.molmed.2016.02.001.","journal-title":"Trends Mol Med"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06261-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06261-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06261-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T15:04:44Z","timestamp":1623251084000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06261-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,9]]},"references-count":43,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6261"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06261-x","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,9]]},"assertion":[{"value":"6 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study has been conducted in accordance with applicable regulatory requirements, the principles of Good Clinical Practice, Good Clinical Laboratory Practices and the ethical principles of the declaration of Helsinki, as adopted by the 18th World Medical Assembly in Helsinki, Finland, in 1964, and subsequent versions. An ethical approval for conducting this study was taken from Nepal health research council (NHRC) and the Oxford Tropical Research Ethics Committee (OxTREC). An informed consent was taken from the parents\/guardians of the neonates for enrollment in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"546"}}