{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:58:53Z","timestamp":1778687933823,"version":"3.51.4"},"reference-count":28,"publisher":"Scientific Scholar","content-domain":{"domain":["ijmr.org.in"],"crossmark-restriction":true},"short-container-title":["Indian J Med Res"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Extensively drug-resistant (XDR) Gram-negative bacterial sepsis is an emerging threat in neonatal intensive care units (NICU). We aimed to determine the epidemiology, pathogen profile, and outcome of neonates with XDR Gram-negative sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted in a newly established NICU in Western India. Data of all neonates admitted between July 2016 and June 2021 were analysed. Standard CDC definitions were used to classify antimicrobial resistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1230 neonates, 31.4% (n=387) had clinically suspected sepsis and 11.5% (n=141) had culture-positive sepsis, accounting for 194 sepsis episodes. Gram-negative sepsis occurred in 117 neonates, of whom 38.4% (45\/117) had XDR Gram-negative sepsis. One-third of these isolates were XDR, predominantly\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      (n=21,44%),\n                      <jats:italic>Acinetobacter<\/jats:italic>\n                      (n=18,37%), and\n                      <jats:italic>Escherichia<\/jats:italic>\n                      species (n=6, 13%). Nearly 60% (28\/48) of XDR Gram-negative isolates were obtained from outborn neonates, and 60% (n=17) were isolated within 48 h of admission. Mortality was significantly higher in neonates with XDR sepsis (21\/45, 46.7%) compared with multidrug-resistant (13\/41, 31.7%) and drug-sensitive Gram-negative sepsis (4\/31, 12.9%) (\n                      <jats:italic>P<\/jats:italic>\n                      =0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation and conclusions<\/jats:title>\n                    <jats:p>The high burden of extensively drug-resistant Gram-negative sepsis and its association with increased mortality underscore the urgent need for strengthened antimicrobial stewardship and surveillance in neonatal intensive care units.<\/jats:p>\n                  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