{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:29:38Z","timestamp":1790292578166,"version":"4.1.0"},"reference-count":65,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1119772"],"award-info":[{"award-number":["OPP1119772"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006823","name":"Boston Children\u2019s Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006823","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Newborn sepsis accounts for more than a third of neonatal deaths globally and one in five neonatal deaths in Ethiopia. The first-line treatment recommended by WHO is the combination of gentamicin with ampicillin or benzylpenicillin. Gram-negative bacteria (GNB) are increasingly resistant to previously effective antibiotics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>Our goal was to estimate the prevalence of antibiotic-resistant gram-negative bacteremia and identify risk factors for antibiotic resistance, among newborns with GNB sepsis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>At a tertiary hospital in Ethiopia, we enrolled a cohort pregnant women and their newborns, between March and December 2017. Newborns who were followed up until 60 days of life for clinical signs of sepsis. Among the newborns with clinical signs of sepsis, blood samples were cultured; bacterial species were identified and tested for antibiotic susceptibility. We described the prevalence of antibiotic resistance, identified newborn, maternal, and environmental factors associated with multidrug resistance (MDR), and combined resistance to ampicillin and gentamicin (AmpGen), using multivariable regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 119 newborns with gram-negative bacteremia, 80 (67%) were born preterm and 82 (70%) had early-onset sepsis. The most prevalent gram-negative species were <jats:italic>Klebsiella pneumoniae<\/jats:italic> 94 (79%) followed by <jats:italic>Escherichia coli<\/jats:italic> 10 (8%). Ampicillin resistance was found in 113 cases (95%), cefotaxime 104 (87%), gentamicin 101 (85%), AmpGen 101 (85%), piperacillin-tazobactam 47 (39%), amikacin 10 (8.4%), and Imipenem 1 (0.8%). Prevalence of MDR was 88% (n = 105). Low birthweight and late-onset sepsis (LOS) were associated with higher risks of AmpGen-resistant infections. All-cause mortality was higher among newborns treated with ineffective antibiotics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>There was significant resistance to current first-line antibiotics and cephalosporins. Additional data are needed from primary care and community settings. Amikacin and piperacillin-tazobactam had lower rates of resistance; however, context-specific assessments of their potential adverse effects, their local availability, and cost-effectiveness would be necessary before selecting a new first-line regimen to help guide clinical decision-making.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0255410","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T17:23:10Z","timestamp":1628011390000},"page":"e0255410","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":56,"title":["Prevalence and risk factors for antimicrobial resistance among newborns with gram-negative sepsis"],"prefix":"10.1371","volume":"16","author":[{"given":"Semaria","family":"Solomon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwasefunmi","family":"Akeju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8630-8510","authenticated-orcid":true,"given":"Oludare A.","family":"Odumade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rozina","family":"Ambachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenebe","family":"Gebreyohannes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimi","family":"Van Wickle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahlet","family":"Abayneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesit","family":"Metaferia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J.","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-4481","authenticated-orcid":true,"given":"Kirsty","family":"Sands","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy R.","family":"Walsh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Milton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7585-0120","authenticated-orcid":true,"given":"Frederick G. B.","family":"Goddard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delayehu","family":"Bekele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2716-1643","authenticated-orcid":true,"given":"Grace J.","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"pone.0255410.ref001","unstructured":"Newborns: reducing mortality [Internet] [updated 19 September 2020; cited 2021 February 2]. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/newborns-reducing-mortality."},{"issue":"6","key":"pone.0255410.ref002","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1111\/apa.13805","article-title":"The Global Network Neonatal Cause of Death algorithm for low\u2010resource settings","volume":"106","author":"AL Garces","year":"2017","journal-title":"Acta Paediatrica"},{"issue":"5","key":"pone.0255410.ref003","doi-asserted-by":"crossref","first-page":"F439","DOI":"10.1136\/archdischild-2014-307636","article-title":"Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India","volume":"100","author":"E Fottrell","year":"2015","journal-title":"Archives of Disease in Childhood-Fetal and Neonatal Edition"},{"key":"pone.0255410.ref004","unstructured":"Neonatal mortality data [Internet] [updated September 2020; cited 2021 Feburary 2]. https:\/\/data.unicef.org\/resources\/dataset\/neonatal-mortality-data\/."},{"key":"pone.0255410.ref005","unstructured":"Ethiopia- UNICEF Data [Internet] [cited 2021 February 2]. https:\/\/data.unicef.org\/wp-content\/uploads\/country_profiles\/Ethiopia\/country%20profile_ETH.pdf."},{"issue":"1","key":"pone.0255410.ref006","first-page":"1","article-title":"Bacterial etiologic agents causing neonatal sepsis and associated risk factors in Gondar, Northwest Ethiopia","volume":"17","author":"F Moges","year":"2017","journal-title":"BMC pediatrics"},{"issue":"1","key":"pone.0255410.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-019-0486-6","article-title":"Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia","volume":"8","author":"A Sorsa","year":"2019","journal-title":"Antimicrobial Resistance & Infection Control"},{"issue":"3","key":"pone.0255410.ref008","doi-asserted-by":"crossref","DOI":"10.4314\/ejhs.v29i3.5","article-title":"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","volume":"29","author":"A Sorsa","year":"2019","journal-title":"Ethiopian journal of health sciences"},{"issue":"1","key":"pone.0255410.ref009","first-page":"4709","article-title":"Bacteriological profile and antimicrobial susceptibility pattern of blood culture isolates among septicemia suspected children in selected hospitals Addis Ababa, Ethiopia","volume":"6","author":"A Negussie","year":"2015","journal-title":"International journal of biological and medical research"},{"issue":"1","key":"pone.0255410.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1756-0500-6-283","article-title":"Bacterial profile and antimicrobial susceptibility pattern in septicemia suspected patients attending Gondar University Hospital, Northwest Ethiopia","volume":"6","author":"M Dagnew","year":"2013","journal-title":"BMC research notes"},{"key":"pone.0255410.ref011","article-title":"Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria?","volume":"12","author":"M Exner","year":"2017","journal-title":"GMS hygiene and infection control"},{"issue":"1","key":"pone.0255410.ref012","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/0974-2727.78563","article-title":"Horizontal transfer of antimicrobial resistance by extended-spectrum \u03b2 lactamase-producing enterobacteriaceae","volume":"3","author":"VK Vaidya","year":"2011","journal-title":"Journal of laboratory physicians"},{"key":"pone.0255410.ref013","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3389\/fped.2018.00277","article-title":"Predictors of mortality in neonates and infants hospitalized with sepsis or serious infections in developing countries: a systematic review","volume":"6","author":"LD Liang","year":"2018","journal-title":"Frontiers in pediatrics"},{"issue":"3","key":"pone.0255410.ref014","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1179\/2046905515Y.0000000029","article-title":"Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality","volume":"35","author":"A Dramowski","year":"2015","journal-title":"Paediatrics and international child health"},{"issue":"1","key":"pone.0255410.ref015","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2334-7-43","article-title":"Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study","volume":"7","author":"B Blomberg","year":"2007","journal-title":"BMC infectious diseases"},{"issue":"4","key":"pone.0255410.ref016","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1542\/peds.110.4.690","article-title":"Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta","volume":"110","author":"TB Hyde","year":"2002","journal-title":"Pediatrics"},{"key":"pone.0255410.ref017","unstructured":"WHO. Pocket book of hospital care for children: guidelines for the management of common childhood illnesses: World Health Organization; 2013."},{"issue":"3","key":"pone.0255410.ref018","first-page":"135","article-title":"Assessment of the incidence of neonatal sepsis, its risk factors, antimicrobials use and clinical outcomes in Bishoftu General Hospital, neonatal intensive care unit, Debrezeit-Ethiopia","volume":"1","author":"MA Woldu","year":"2017","journal-title":"Int J Contemp Pediatrics"},{"key":"pone.0255410.ref019","unstructured":"Fuchs A, Bielicki J, Mathur S, Sharland M, Van Den Anker J. Antibiotic use for sepsis in neonates and children: 2016 evidence update. WHO Reviews. 2016."},{"issue":"10014","key":"pone.0255410.ref020","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: a worldwide challenge","volume":"387","author":"R Laxminarayan","year":"2016","journal-title":"The Lancet"},{"issue":"3","key":"pone.0255410.ref021","first-page":"136","article-title":"Changing pattern of bacterial isolates and antimicrobial susceptbility in neonatal infections in Korle Bu Teaching Hospital, Ghana","volume":"84","author":"C Enweronu-Laryea","year":"2007","journal-title":"East African medical journal"},{"issue":"7","key":"pone.0255410.ref022","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1097\/INF.0000000000001154","article-title":"Etiology, antibiotic resistance and risk factors for neonatal sepsis in a large referral center in Zambia","volume":"35","author":"M Kabwe","year":"2016","journal-title":"The Pediatric infectious disease journal"},{"issue":"2","key":"pone.0255410.ref023","doi-asserted-by":"crossref","first-page":"99","DOI":"10.7196\/SAMJ.2018.v108i2.12601","article-title":"Neonatal and paediatric bloodstream infections: Pathogens, antimicrobial resistance patterns and prescribing practice at Khayelitsha District Hospital, Cape Town, South Africa","volume":"108","author":"H Crichton","year":"2018","journal-title":"South African Medical Journal"},{"issue":"11","key":"pone.0255410.ref024","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1016\/S1473-3099(19)30414-1","article-title":"Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines","volume":"19","author":"U Okomo","year":"2019","journal-title":"The Lancet Infectious diseases"},{"issue":"4","key":"pone.0255410.ref025","first-page":"293","article-title":"Bacteriological profile and resistant pattern of clinical isolates from pediatric patients, Gondar University Teaching Hospital, Gondar, Northwest Ethiopia","volume":"48","author":"G Yismaw","year":"2010","journal-title":"Ethiopian medical journal"},{"issue":"3","key":"pone.0255410.ref026","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"A-P Magiorakos","year":"2012","journal-title":"Clinical microbiology and infection"},{"issue":"2","key":"pone.0255410.ref027","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.pcl.2012.12.003","article-title":"Neonatal infectious diseases: evaluation of neonatal sepsis","volume":"60","author":"A Camacho-Gonzalez","year":"2013","journal-title":"Pediatric Clinics of North America"},{"issue":"8","key":"pone.0255410.ref028","doi-asserted-by":"crossref","first-page":"e1001502","DOI":"10.1371\/journal.pmed.1001502","article-title":"Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis","volume":"10","author":"GJ Chan","year":"2013","journal-title":"PLoS Med"},{"issue":"4","key":"pone.0255410.ref029","doi-asserted-by":"crossref","first-page":"F391","DOI":"10.1136\/archdischild-2017-313595","article-title":"Why are preterm newborns at increased risk of infection?","volume":"103","author":"A Collins","year":"2018","journal-title":"Archives of Disease in Childhood-Fetal and Neonatal Edition"},{"issue":"1","key":"pone.0255410.ref030","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1128\/CMR.00031-13","article-title":"Early-onset neonatal sepsis","volume":"27","author":"KA Simonsen","year":"2014","journal-title":"Clinical microbiology reviews"},{"key":"pone.0255410.ref031","unstructured":"Burroughs T, Najafi M, Lemon SM, Knobler SL. The resistance phenomenon in microbes and infectious disease vectors: implications for human health and strategies for containment: workshop summary. 2003."},{"issue":"4","key":"pone.0255410.ref032","doi-asserted-by":"crossref","first-page":"347","DOI":"10.3201\/eid0804.010312","article-title":"Antimicrobial use and antimicrobial resistance: a population perspective","volume":"8","author":"M Lipsitch","year":"2002","journal-title":"Emerging infectious diseases"},{"issue":"1","key":"pone.0255410.ref033","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.pedneo.2017.06.001","article-title":"Clinical characteristics and epidemiology of sepsis in the neonatal intensive care unit in the era of multi-drug resistant organisms: a retrospective review","volume":"59","author":"D Yusef","year":"2018","journal-title":"Pediatrics & Neonatology"},{"issue":"9","key":"pone.0255410.ref034","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1177\/0009922811406260","article-title":"The association of intrapartum antibiotic exposure with the incidence and antibiotic resistance of infantile late-onset serious bacterial infections","volume":"50","author":"L Ashkenazi-Hoffnung","year":"2011","journal-title":"Clinical pediatrics"},{"issue":"1","key":"pone.0255410.ref035","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000342215","article-title":"Correlation of bacterial type and antibiotic sensitivity with maternal antibiotic exposure in early-onset neonatal sepsis","volume":"103","author":"R Bromiker","year":"2013","journal-title":"Neonatology"},{"issue":"3","key":"pone.0255410.ref036","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1542\/peds.2004-2421","article-title":"Association of intrapartum antibiotic exposure and late-onset serious bacterial infections in infants","volume":"116","author":"TS Glasgow","year":"2005","journal-title":"Pediatrics"},{"issue":"4","key":"pone.0255410.ref037","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/S0002-9378(99)70307-8","article-title":"Antibiotic use in pregnancy and drug-resistant infant sepsis","volume":"181","author":"BM Mercer","year":"1999","journal-title":"American journal of obstetrics and gynecology"},{"issue":"2","key":"pone.0255410.ref038","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1542\/peds.2005-3083","article-title":"Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use","volume":"118","author":"SJ Schrag","year":"2006","journal-title":"Pediatrics"},{"key":"pone.0255410.ref039","unstructured":"WHO. World Health Organization recommendation on intrapartum antibiotic administration to women with group B Streptococcus (GBS) colonization for prevention of early neonatal GBS infection. WHO Reprod Heal Libr. 2015."},{"issue":"1","key":"pone.0255410.ref040","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1080\/00365540500372879","article-title":"The use of piperacillin\/tazobactam (in association with amikacin) in neonatal sepsis: efficacy and safety data","volume":"38","author":"O Flidel-Rimon","year":"2006","journal-title":"Scandinavian journal of infectious diseases"},{"key":"pone.0255410.ref041","unstructured":"Breakpoint tables for interpretation of MICs and zone diameters, version 10.0, 2020 [cited 2021 February 2]."},{"issue":"4","key":"pone.0255410.ref042","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1038\/s41564-021-00870-7","article-title":"Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low-and middle-income countries","volume":"6","author":"K Sands","year":"2021","journal-title":"Nature microbiology"},{"issue":"1","key":"pone.0255410.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Z Bursac","year":"2008","journal-title":"Source code for biology and medicine"},{"issue":"1","key":"pone.0255410.ref044","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jtumed.2019.12.005","article-title":"Pattern of bacterial profile and antibiotic susceptibility among neonatal sepsis cases at Cairo University Children Hospital","volume":"15","author":"MN Almohammady","year":"2020","journal-title":"Journal of Taibah University Medical Sciences"},{"issue":"1","key":"pone.0255410.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-017-0225-9","article-title":"Emerging antimicrobial resistance in early and late-onset neonatal sepsis","volume":"6","author":"L Mohsen","year":"2017","journal-title":"Antimicrobial Resistance & Infection Control"},{"key":"pone.0255410.ref046","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/4323769","article-title":"Retrospective assessment of antibiotics prescribing at public primary healthcare facilities in Addis Ababa, Ethiopia","volume":"2018","author":"F Worku","year":"2018","journal-title":"Interdisciplinary perspectives on infectious diseases"},{"key":"pone.0255410.ref047","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1128\/9781555819286.ch17","article-title":"Mechanisms of antibiotic resistance","author":"JM Munita","year":"2016","journal-title":"Virulence mechanisms of bacterial pathogens"},{"key":"pone.0255410.ref048","doi-asserted-by":"crossref","unstructured":"Senok AC, Botta GA, Soge OO. Emergence and spread of antimicrobial-resistant pathogens in an era of globalization. Hindawi; 2012.","DOI":"10.1155\/2012\/286703"},{"key":"pone.0255410.ref049","unstructured":"WHO. Second meeting of the subcommittee of the expert committee on the selection and use of essential medicines. Geneva: World Health Organization. 2018."},{"issue":"7","key":"pone.0255410.ref050","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/jp.2012.169","article-title":"Results of a two-center, before and after study of piperacillin\u2013tazobactam versus ampicillin and gentamicin as empiric therapy for suspected sepsis at birth in neonates\u2a7d 1500 g","volume":"33","author":"E Chong","year":"2013","journal-title":"Journal of Perinatology"},{"issue":"1","key":"pone.0255410.ref051","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1177\/2049936115621709","article-title":"Carbapenem resistance: overview of the problem and future perspectives","volume":"3","author":"G Meletis","year":"2016","journal-title":"Therapeutic advances in infectious disease"},{"key":"pone.0255410.ref052","first-page":"1","volume-title":"Fluoroquinolone use in paediatrics: focus on safety and place in therapy","author":"JA Goldman","year":"2011"},{"issue":"03","key":"pone.0255410.ref053","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1055\/s-0038-1675582","article-title":"Tigecycline Use in Neonates: 5-Year Experience of a Tertiary Center","volume":"14","author":"MS \u0130pek","year":"2019","journal-title":"Journal of Pediatric Infectious Diseases"},{"issue":"6","key":"pone.0255410.ref054","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1111\/jpc.14883","article-title":"Potential of fosfomycin in treating multidrug\u2010resistant infections in children","volume":"56","author":"PC Williams","year":"2020","journal-title":"Journal of paediatrics and child health"},{"issue":"6","key":"pone.0255410.ref055","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1111\/eva.12808","article-title":"Five rules for resistance management in the antibiotic apocalypse, a road map for integrated microbial management","volume":"12","author":"B Raymond","year":"2019","journal-title":"Evolutionary applications"},{"issue":"1","key":"pone.0255410.ref056","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12887-018-1176-x","article-title":"Bacteriological profile and antibiotic susceptibility of neonatal sepsis in neonatal intensive care unit of a tertiary hospital in Nepal","volume":"18","author":"B Pokhrel","year":"2018","journal-title":"BMC pediatrics"},{"issue":"5","key":"pone.0255410.ref057","doi-asserted-by":"crossref","first-page":"e0215666","DOI":"10.1371\/journal.pone.0215666","article-title":"Multiple antibiotic resistance as a risk factor for mortality and prolonged hospital stay: A cohort study among neonatal intensive care patients with hospital-acquired infections caused by gram-negative bacteria in Vietnam","volume":"14","author":"L Peters","year":"2019","journal-title":"PloS one"},{"issue":"4","key":"pone.0255410.ref058","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s12199-015-0468-0","article-title":"Understanding the contribution of environmental factors in the spread of antimicrobial resistance","volume":"20","author":"S Fletcher","year":"2015","journal-title":"Environmental health and preventive medicine"},{"issue":"10","key":"pone.0255410.ref059","doi-asserted-by":"crossref","first-page":"705","DOI":"10.3390\/antibiotics9100705","article-title":"Investigation of Outbreaks of Extended-Spectrum Beta-Lactamase-Producing Klebsiella Pneumoniae in Three Neonatal Intensive Care Units Using Whole Genome Sequencing","volume":"9","author":"S Frenk","year":"2020","journal-title":"Antibiotics"},{"key":"pone.0255410.ref060","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nmni.2015.01.002","article-title":"Associations of the major international high-risk resistant clones and virulent clones with specific ompK36 allele groups in Klebsiella pneumoniae in Taiwan","volume":"5","author":"J Yan","year":"2015","journal-title":"New microbes and new infections"},{"key":"pone.0255410.ref061","first-page":"334169","article-title":"Co-outbreak of ST37 and a novel ST3006 Klebsiella pneumoniae from multi-site infection in a neonatal intensive care unit: a retrospective study","author":"D Chen","year":"2018","journal-title":"bioRxiv"},{"issue":"1","key":"pone.0255410.ref062","first-page":"1","article-title":"Comparisons of microbiological characteristics and antibiotic resistance of Klebsiella pneumoniae isolates from urban rodents, shrews, and healthy people","volume":"20","author":"X-s Zhong","year":"2020","journal-title":"BMC microbiology"},{"issue":"1","key":"pone.0255410.ref063","doi-asserted-by":"crossref","first-page":"dlab001","DOI":"10.1093\/jacamr\/dlab001","article-title":"High prevalence of bla CTX-M-15 and nosocomial transmission of hypervirulent epidemic clones of Klebsiella pneumoniae at a tertiary hospital in Ethiopia","volume":"3","author":"T Sewunet","year":"2021","journal-title":"JAC-Antimicrobial Resistance"},{"issue":"1","key":"pone.0255410.ref064","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1080\/21505594.2020.1809322","article-title":"Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China","volume":"11","author":"C Liu","year":"2020","journal-title":"Virulence"},{"issue":"11","key":"pone.0255410.ref065","doi-asserted-by":"crossref","first-page":"5315","DOI":"10.1128\/AAC.01059-13","article-title":"In vitro and in vivo activities of antibiotic PM181104","volume":"57","author":"G Mahajan","year":"2013","journal-title":"Antimicrobial agents and chemotherapy"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255410","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T17:24:14Z","timestamp":1628011454000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255410"}},"subtitle":[],"editor":[{"given":"Monica","family":"Cartelle Gestal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,3]]},"references-count":65,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0255410","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,3]]}}}