{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:34:48Z","timestamp":1787236488377,"version":"build-2736575974"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Neonatal sepsis continues to be one of the leading causes of morbidity and death, particularly in low- and middle-income countries (LMICs). This study aimed to evaluate the microbiological etiology, temporal trends, and antibiotic resistance patterns in a tertiary neonatal intensive care unit (NICU) over a six-year period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included neonates admitted to a tertiary neonatal intensive care unit between 2018 and 2024. Early-onset infections were defined as infections occurring within the first 72 hours of life, while late-onset infections were defined as infections occurring after 72 hours. Logistic regression analysis was used to assess temporal trends and identify factors associated with multidrug-resistant infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Microbial growth was observed in 891 (30.0%) of the total samples. A total of 891 isolates (30.0% of all samples) with complete data were included in the final study after duplicate and contaminated isolates were removed. Among these isolates, 472 (53.0%) were\n                      <jats:italic>Gram-positive bacteria<\/jats:italic>\n                      , 366 (41.1%) were\n                      <jats:italic>Gram-negative bacteria<\/jats:italic>\n                      , and 53 (5.9%) were\n                      <jats:italic>Candida spp. isolates<\/jats:italic>\n                      . isolates. In addition to a greater proportion of\n                      <jats:italic>Gram-negative organisms<\/jats:italic>\n                      (43.6% vs. 35.4%) and\n                      <jats:italic>Candida species<\/jats:italic>\n                      (7.5% vs. 2.6%), late-onset infections showed considerably higher culture-positive rates (37.7% vs. 20.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) than early-onset infections. On the other hand,\n                      <jats:italic>Gram-positive<\/jats:italic>\n                      organisms predominated in early-onset infections (62.0% vs. 48.9%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). In Multivariate logistic regression analysis, study year was not independently associated with MDR after adjustment (aOR: 1.06, 95% CI: 0.98\u20131.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.169), whereas late-onset infection was still independently linked with MDR infection (aOR: 2.53, 95% CI: 1.84\u20133.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Despite changes in MDR rates throughout the course of the research years,\n                      <jats:italic>carbapenem resistance<\/jats:italic>\n                      demonstrated a significant growing trend over time (\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u2009=\u20090.004). Notably, none of the commonly used empirical antibiotics met the recommended susceptibility level of \u226580%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This six-year study reveals a significant burden of neonatal infections in the NICU, with\n                      <jats:italic>Candida spp.<\/jats:italic>\n                      and\n                      <jats:italic>Gram-negative<\/jats:italic>\n                      organisms predominating in late-onset infections and Gram-positive organisms in early-onset infections.\n                      <jats:italic>Carbapenem resistance<\/jats:italic>\n                      dramatically increased over time, and late-onset infection was independently linked to multidrug resistance. These results highlight the necessity of stronger IPC, localized antimicrobial stewardship, updated empirical treatment guidelines, and regular AMR surveillance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1888678","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:36:19Z","timestamp":1787031379000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Microbial etiology and antimicrobial resistance patterns in neonates admitted to a tertiary neonatal intensive care unit in Mogadishu, Somalia"],"prefix":"10.3389","volume":"14","author":[{"given":"Ali Kutta","family":"\u00c7EL\u0130K","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Mogadishu-Somalia-Turkiye Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigad Abdisad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention Control (IPC), Turkey Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]},{"name":"Tropical Medicine and Infectious Diseases, School of Postgraduate Studies, Benadir University","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah Abdullahi","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mogadishu-Somalia-Turkiye Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suad Abdikarim","family":"ISSE","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention Control (IPC), Turkey Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mucahit","family":"T\u00dcRKAN","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention Control (IPC), Turkey Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdikarim Abdi","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Environmental Health and Climate, IPC Section, Ministry of Health and Human Services","place":["Mogadishu, Somalia"]},{"name":"Department of Medicine, Faculty of Medicine and Surgery, Salaam University","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liban Ade","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Mogadishu-Somalia-Turkiye Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edanur","family":"Ye\u015fil","sequence":"additional","affiliation":[{"name":"Department of Pediatric Infectious Diseases, Mersin University Faculty of Medicine","place":["Mersin, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed A. M.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Faculty of Medicine and Surgery, Mogadishu University","place":["Mogadishu, Somalia"]},{"name":"Department of Paediatric & Congenital Cardiology, Mogadishu Heart Center","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1136\/archdischild-2020-320217","article-title":"Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis","volume":"106","author":"Fleischmann","year":"2021","journal-title":"Arch Dis Child"},{"key":"B3","volume-title":"Somalia Maternal and Newborn Health Country Profile","year":"2023"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1693062","DOI":"10.3389\/fped.2025.1693062","article-title":"Individual and community-level determinants of neonatal mortality in Somalia","volume":"13","author":"Kahie","year":"2025","journal-title":"Front Pediatr"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e391","DOI":"10.1093\/cid\/ciaa869","article-title":"The role of biomarkers in suspected neonatal sepsis","volume":"73","author":"Weitkamp","year":"2021","journal-title":"Clin Infect Dis"},{"key":"B6","volume-title":"Newborns: Improving Survival and Well-Being","year":"2024"},{"key":"B7","doi-asserted-by":"publisher","first-page":"581753","DOI":"10.2147\/IDR.S581753","article-title":"Critical gaps in infection prevention and control in Somalia: insights from the 2024 nationwide harmonized health facility assessment data","volume":"19","author":"Adam","year":"2026","journal-title":"Infect Drug Resist"},{"key":"B8","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1186\/s12913-026-14377-6","article-title":"Healthcare facility accreditation status and associated factors in Somalia: evidence from the 2022\u20132023 harmonized health facility assessment","volume":"26","author":"Osman","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"3605","DOI":"10.2147\/IDR.S525134","article-title":"Assessment of medical waste segregation, disposal practices for infectious and sharps waste in healthcare facilities in Somalia: implications for infection prevention and control","volume":"18","author":"Adam","year":"2025","journal-title":"Infect Drug Resist"},{"key":"B10","article-title":"Neonatal sepsis","volume-title":"StatPearls","author":"Singh","year":"2026"},{"key":"B11","doi-asserted-by":"publisher","first-page":"170","DOI":"10.5152\/TurkPediatriArs.2015.2627","article-title":"Factors which affect mortality in neonatal sepsis","volume":"50","author":"Turhan","year":"2015","journal-title":"Turk Pediatri Ars"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e1003787","DOI":"10.1371\/journal.pmed.1003787","article-title":"Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: a systematic review and meta-analysis","volume":"18","author":"Wen","year":"2021","journal-title":"PLoS Med"},{"key":"B13","year":""},{"key":"B14","doi-asserted-by":"publisher","first-page":"e1786","DOI":"10.1016\/S2214-109X(25)00326-2","article-title":"Management of possible serious infections in young infants","volume":"13","author":"Awasthi","year":"2025","journal-title":"Lancet Glob Heal"},{"key":"B15","first-page":"1","article-title":"Antimicrobial resistance in Somalia: a silent public health crisis demanding immediate action","volume":"19","author":"Jimale","year":"2026","journal-title":"Infect Drug Resist"},{"key":"B16","first-page":"1","article-title":"Antimicrobial resistance in Somalia: surveillance gaps, stewardship barriers, and one health priorities","volume":"19","author":"Jimale","year":"2026","journal-title":"Infect Drug Resist"},{"key":"B17","year":""},{"key":"B18","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1186\/s12879-025-10562-w","article-title":"Prevalence of multidrug-resistant bacteria in West Africa","volume":"25","author":"Diop","year":"2025","journal-title":"BMC Infect Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3390\/antibiotics14010006","article-title":"Neonatal sepsis: a comprehensive review","volume":"14","author":"Kariniotaki","year":"2025","journal-title":"Antibiotics (Basel)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1186\/s12879-017-2713-1","article-title":"Antimicrobial resistance in Africa","volume":"17","author":"Tadesse","year":"2017","journal-title":"BMC Infect Dis"},{"key":"B21","volume-title":"Antimicrobial Resistance: Global Report on Surveillance","year":"2014"},{"key":"B22","volume-title":"Global Burden of Antimicrobial Resistance: Somalia Profile","year":"2023"},{"key":"B23","volume-title":"Prevalence of Antimicrobial Resistance in Somalia: A Systematic Review","year":""},{"key":"B24","doi-asserted-by":"publisher","first-page":"606434","DOI":"10.2147\/IDR.S606434","article-title":"Antimicrobial resistance in intensive care units in Somalia: a commentary on measurement gaps and facility-level priorities for infection prevention and stewardship","volume":"19","author":"Hassan","year":"2026","journal-title":"Infect Drug Resist"},{"key":"B25","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1186\/s13756-025-01584-9","article-title":"Assessment of infection prevention and control in Somali healthcare facilities using the WHO infection prevention and control assessment framework","volume":"14","author":"Adam","year":"2025","journal-title":"Antimicrob Resist Infect Control"},{"key":"B26","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1542\/peds.2010-2217","article-title":"Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease","volume":"127","author":"Stoll","year":"2011","journal-title":"Pediatrics"},{"key":"B27","doi-asserted-by":"publisher","first-page":"250","DOI":"10.3390\/antibiotics13030250","article-title":"An overview of antibiotic therapy for early- and late-onset neonatal sepsis: current strategies and future prospects","volume":"13","author":"Boscarino","year":"2024","journal-title":"Antibiotics (Basel)"},{"key":"B28","first-page":"F257","article-title":"Neonatal sepsis","volume-title":"StatPearls","author":"Singh","year":"2022"},{"key":"B29","doi-asserted-by":"publisher","first-page":"5517","DOI":"10.1007\/s00431-024-05811-0","article-title":"Management of neonates at risk of early-onset sepsis: a probability-based approach and recent literature appraisal","volume":"183","author":"Stocker","year":"2024","journal-title":"Eur J Pediatr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/11795565241281337","article-title":"Neonatal sepsis: aetiology, pathophysiology, diagnostic advances and management strategies","volume":"18","author":"Raturi","year":"2024","journal-title":"Clin Med Insights Pediatr"},{"key":"B31","doi-asserted-by":"publisher","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":"Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"B32","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/S2213-2600(18)30063-8","article-title":"The global burden of paediatric and neonatal sepsis: a systematic review","volume":"6","author":"Fleischmann-Struzek","year":"2018","journal-title":"Lancet Respir Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1770","DOI":"10.1016\/S0140-6736(17)31002-4","article-title":"Neonatal sepsis","volume":"390","author":"Shane","year":"2017","journal-title":"Lancet"},{"key":"B34","volume-title":"Global Report on the Epidemiology and Burden of Sepsis","year":"2020"},{"key":"B35","doi-asserted-by":"publisher","first-page":"F257","DOI":"10.1136\/archdischild-2014-306213","article-title":"Late-onset neonatal sepsis: recent developments","volume":"100","author":"Dong","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1700766","DOI":"10.3389\/fped.2025.1700766","article-title":"Pathogen distribution, antimicrobial resistance and attributable cost analysis of neonatal sepsis in neonatal intensive care units: a propensity score matching study","volume":"13","author":"Zhang","year":"2025","journal-title":"Front Pediatr"},{"key":"B37","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1016\/j.jinf.2013.09.011","article-title":"Neonatal sepsis: progress towards improved outcomes","volume":"68","author":"Shane","year":"2014","journal-title":"J Infect"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e1155","DOI":"10.1542\/peds.2010-3360","article-title":"Estimating the probability of neonatal early-onset infection","volume":"128","author":"Puopolo","year":"2011","journal-title":"Pediatrics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1128\/CMR.00029-11","article-title":"Misclassification of coagulase-negative staphylococci in bloodstream infections","volume":"25","author":"Brooks","year":"2012","journal-title":"Clin Microbiol Rev"},{"key":"B40","volume-title":"Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report","year":"2022"},{"key":"B41","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1542\/peds.2009-2959","article-title":"Neonatal outcomes of extremely preterm infants","volume":"126","author":"Stoll","year":"2010","journal-title":"Pediatrics"},{"key":"B42","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.clp.2014.10.003","article-title":"Late-onset sepsis in the neonatal intensive care unit","volume":"42","author":"Shane","year":"2015","journal-title":"Clin Perinatol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.pcl.2012.12.003","article-title":"Neonatal infectious diseases: evaluation of EOS and LOS","volume":"60","author":"Camacho-Gonzalez","year":"2013","journal-title":"Pediatr Clin North Am"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1542\/peds.2012-0541","article-title":"Management of neonates with suspected or proven early-onset bacterial sepsis","volume":"129","author":"Polin","year":"2012","journal-title":"Pediatrics"},{"key":"B45","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1542\/peds.2004-2292","article-title":"Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months","volume":"117","author":"Benjamin","year":"2006","journal-title":"Pediatrics"},{"key":"B46","doi-asserted-by":"publisher","first-page":"e102","DOI":"10.1542\/peds.2011-1546","article-title":"Early and late onset sepsis in very-low-birth-weight infants","volume":"129","author":"Hornik","year":"2012","journal-title":"Pediatrics"},{"key":"B47","doi-asserted-by":"publisher","first-page":"F474","DOI":"10.1136\/archdischild-2017-313238","article-title":"Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network","volume":"103","author":"Cailes","year":"2018","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B48","doi-asserted-by":"publisher","first-page":"e1066","DOI":"10.1016\/S2214-109X(17)30362-5","article-title":"Tackling antimicrobial resistance in neonatal sepsis","volume":"5","author":"Folgori","year":"2017","journal-title":"Lancet Glob Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.cmi.2017.07.010","article-title":"Antimicrobial resistance in neonatal sepsis","volume":"24","author":"Cox","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"B50","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1186\/s12913-026-14958-5","article-title":"Facility-level determinants of infection prevention and control monitoring in Somalia: evidence from the 2024 harmonized health facility assessment","volume":"26","author":"Adam","year":"2026","journal-title":"BMC Health Serv Res"},{"key":"B51","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: a worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"B52","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jpeds.2018.05.048","article-title":"Neonatal sepsis of early onset, and hospital-acquired and community-acquired late onset: a prospective population-based cohort study","volume":"201","author":"Giannoni","year":"2018","journal-title":"J Pediatr"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1093\/cid\/cix083","article-title":"The epidemiology of carbapenem-resistant Enterobacteriaceae","volume":"64","author":"Murdoch","year":"2017","journal-title":"Clin Infect Dis"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.3201\/eid1710.110655","article-title":"Global spread of carbapenemase-producing Enterobacteriaceae","volume":"17","author":"Nordmann","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"B55","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1186\/s12879-016-1913-4","article-title":"Neonatal bloodstream infections in a Ghanaian tertiary hospital: are the current antibiotic recommendations adequate?","volume":"16","author":"Labi","year":"2016","journal-title":"BMC Infect Dis"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1888678\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:30:08Z","timestamp":1787232608000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1888678\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":55,"alternative-id":["10.3389\/fped.2026.1888678"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1888678","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1888678"}}