{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T19:56:47Z","timestamp":1785614207297,"version":"3.56.0"},"reference-count":76,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Neonatal sepsis is a major cause of infant mortality, and it accounts for a significant consumption of antimicrobials in paediatrics. This is the first comprehensive study on neonatal sepsis in Hong Kong. Methods: From 2014 to 2023, all neonates admitted to a single institution with culture-proven infections from the blood and\/or cerebrospinal fluid were selected and reviewed retrospectively. The infecting organisms, their antibiotic nonsusceptibility pattern, and the concordance of empirical antimicrobial therapy with the microbiological profiles were described and were further compared between infants of normal\/low birth weight (\u22651.5 kg) and very low\/extremely low birth weight (&lt;1.5 kg), early-onset sepsis (&lt;72 h), and late-onset sepsis (4\u201328 days), the first and the second 5-year periods (2014\u20132018 vs. 2019\u20132023). Results: After contaminants were excluded, there were 118 affected neonates with 125 organisms identified. Fifty-nine were male. Thirty-four were very low\/extremely low birth weight infants, and twenty-eight infants had early-onset sepsis. Patient demographics and the microbiology findings did not differ between the first 5 years and the latter 5 years. However, the incidence of neonatal sepsis was significantly lower in the latter 5 years (3.23 vs. 1.61 per 1000 live births, p &lt; 0.001), the period that coincided with the COVID-19 pandemic. Escherichia coli was the most common Gram-negative pathogen. Streptococcus agalactiae and Streptococcus bovis group infections were more common in early-onset sepsis, while coagulase-negative Staphylococcus and non-E. coli Gram-negative pathogens were more likely to occur in late-onset sepsis. In very low\/extremely low birth weight infants, the rate of cefotaxime or ceftriaxone nonsusceptibility among Gram-negative isolates was higher (p = 0.01), and concordance of empirical antimicrobial therapy was lower (p = 0.006). Conclusions: Management of neonatal sepsis remains challenging, and there is a need for optimising antimicrobial therapy, especially in preterm patients. Antepartum screening with intrapartum antibiotic prophylaxis is effective in reducing the risk of early-onset sepsis associated with S. agalactiae, while stringent infection control measures are important for the prevention of late-onset sepsis.<\/jats:p>","DOI":"10.3390\/pathogens14030276","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T10:16:45Z","timestamp":1741861005000},"page":"276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A 10-Year Study of Neonatal Sepsis from Tuen Mun Hospital, Hong Kong"],"prefix":"10.3390","volume":"14","author":[{"given":"Pascoe","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1342-9505","authenticated-orcid":false,"given":"Eugene","family":"Sin","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kam-Tong","family":"Yip","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Tuen Mun Hospital, Hospital Authority, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"ref_2","doi-asserted-by":"crossref","first-page":"e661","DOI":"10.1016\/S2214-109X(22)00043-2","article-title":"Neonatal Sepsis and Mortality in Low-Income and Middle-Income Countries from a Facility-Based Birth Cohort: An International Multisite Prospective Observational Study","volume":"10","author":"Milton","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/MOP.0000000000000315","article-title":"Defining Neonatal Sepsis","volume":"28","author":"Wynn","year":"2016","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"(2020). Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797. Obstet. Gynecol., 135, e51\u2013e72.","DOI":"10.1097\/AOG.0000000000003668"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"766","DOI":"10.3109\/14767058.2014.934804","article-title":"Intrapartum GBS Screening and Antibiotic Prophylaxis: A European Consensus Conference","volume":"28","author":"Melin","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_6","unstructured":"World Health Organization (2024). WHO Recommendation on Screening of Pregnant Women for Intrapartum Antibiotic Prophylaxis for the Prevention of Early Onset Group B Streptococcus Disease in Newborns, World Health Organization, Human Reproduction Programme."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Li, J., Shen, L., and Qian, K. (2023). Global, Regional, and National Incidence and Mortality of Neonatal Sepsis and Other Neonatal Infections, 1990\u20132019. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1139832"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1542\/pir.2020-001164","article-title":"Early-Onset Sepsis in Newborns","volume":"44","author":"Roth","year":"2023","journal-title":"Pediatr. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1542\/neo.23-10-e738","article-title":"Updates in Late-Onset Sepsis: Risk Assessment, Therapy, and Outcomes","volume":"23","author":"Coggins","year":"2022","journal-title":"Neoreviews"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1038\/pr.2017.134","article-title":"Diagnostics for Neonatal Sepsis: Current Approaches and Future Directions","volume":"82","author":"Bendel","year":"2017","journal-title":"Pediatr. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/s41390-021-01696-z","article-title":"Mohan Pammi, null Diagnosis of Neonatal Sepsis: The Past, Present and Future","volume":"91","author":"Celik","year":"2022","journal-title":"Pediatr. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/tropej\/fmu079","article-title":"Challenges in the Diagnosis and Management of Neonatal Sepsis","volume":"61","author":"Ochoa","year":"2015","journal-title":"J. Trop. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100727","DOI":"10.1016\/j.eclinm.2021.100727","article-title":"A Global Point Prevalence Survey of Antimicrobial Use in Neonatal Intensive Care Units: The No-More-Antibiotics and Resistance (NO-MAS-R) Study","volume":"32","author":"Prusakov","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.cmi.2022.06.006","article-title":"Can the History of Empiric Antibiotic Treatment for Neonatal Sepsis Inform Future Global Trials?","volume":"28","author":"Sharland","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","unstructured":"World Health Organization (2013). Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses, World Health Organization. [2nd ed.]."},{"key":"ref_16","unstructured":"(2021). Neonatal Infection: Antibiotics for Prevention and Treatment, National Institute for Health and Care Excellence."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e20182894","DOI":"10.1542\/peds.2018-2894","article-title":"Management of Neonates Born at \u226535 0\/7 Weeks\u2019 Gestation With Suspected or Proven Early-Onset Bacterial Sepsis","volume":"142","author":"Puopolo","year":"2018","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1097\/INF.0000000000004485","article-title":"Beyond Early- and Late-Onset Neonatal Sepsis Definitions: What Are the Current Causes of Neonatal Sepsis Globally? A Systematic Review and Meta-Analysis of the Evidence","volume":"43","author":"Harrison","year":"2024","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"350","DOI":"10.3345\/cep.2021.00668","article-title":"Neonatal Sepsis-Causing Bacterial Pathogens and Outcome of Trends of Their Antimicrobial Susceptibility a 20-Year Period at a Neonatal Intensive Care Unit","volume":"65","author":"Song","year":"2022","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_20","unstructured":"(2025, February 22). 2021 Population Census-District Profiles, Available online: https:\/\/www.census2021.gov.hk\/en\/district_profiles.html."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2023062223","DOI":"10.1542\/peds.2023-062223","article-title":"ISRAEL NEONATAL NETWORK Late-Onset Sepsis in Very Low Birth Weight Infants","volume":"152","author":"Klinger","year":"2023","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2024067675","DOI":"10.1542\/peds.2024-067675","article-title":"Late-Onset Sepsis Among Extremely Preterm Infants During the COVID-19 Pandemic","volume":"155","author":"Mukhopadhyay","year":"2025","journal-title":"Pediatrics"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1542\/peds.110.2.285","article-title":"Late-Onset Sepsis in Very Low Birth Weight Neonates: The Experience of the NICHD Neonatal Research Network","volume":"110","author":"Stoll","year":"2002","journal-title":"Pediatrics"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1038\/s41390-021-01749-3","article-title":"Neonatal Sepsis Definitions from Randomised Clinical Trials","volume":"93","author":"Hayes","year":"2023","journal-title":"Pediatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","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":"ref_26","doi-asserted-by":"crossref","unstructured":"Ceparano, M., Sciurti, A., Isonne, C., Baccolini, V., Migliara, G., Marzuillo, C., Natale, F., Terrin, G., and Villari, P. (2023). The Collaborating Group Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072621"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e1002","DOI":"10.1542\/peds.2014-3226","article-title":"Prediction Models for Neonatal Health Care\u2013Associated Sepsis: A Meta-Analysis","volume":"135","author":"Verstraete","year":"2015","journal-title":"Pediatrics"},{"key":"ref_28","unstructured":"(2025, February 15). Hospital Authority Statistical Report. Available online: https:\/\/www3.ha.org.hk\/data\/HAStatistics\/StatisticalReport\/."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"583","DOI":"10.3233\/NPM-210961","article-title":"COVID-19 Pandemic Lockdown Effect on Neonatal Hospital Admissions from the Community","volume":"15","author":"Almeida","year":"2022","journal-title":"J. Neonatal-Perinat. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"11795565241281337","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":"ref_31","doi-asserted-by":"crossref","unstructured":"Kariniotaki, C., Thomou, C., Gkentzi, D., Panteris, E., Dimitriou, G., and Hatzidaki, E. (2024). Neonatal Sepsis: A Comprehensive Review. Antibiotics, 14.","DOI":"10.3390\/antibiotics14010006"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Geleta, D., Abebe, G., Workneh, N., and Beyene, G. (2023). Epidemiologic Features of Neonatal Sepsis and Its COVID-19 Associated Temporal Patterns in Jimma Medical Center, Ethiopia: A Joinpoint Regression Analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0291610"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/INF.0000000000003489","article-title":"Relationship Between COVID-19 Lockdown and Epidemiology of Neonatal Sepsis","volume":"41","author":"Dutta","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"fmac106","DOI":"10.1093\/tropej\/fmac106","article-title":"Covid-Period-Associated Changes in Organism Profile of Neonatal Sepsis in a Tertiary Center from East India","volume":"69","author":"Mukherjee","year":"2022","journal-title":"J. Trop. Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00431-021-04254-1","article-title":"COVID-19 Pandemic in the Neonatal Intensive Care Unit: Any Effect on Late-Onset Sepsis and Necrotizing Enterocolitis?","volume":"181","author":"Indrio","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1159\/000536570","article-title":"The Incidence of Necrotizing Enterocolitis and Late-Onset Sepsis during the COVID-19 Pandemic in Sweden: A Population-Based Cohort Study","volume":"121","author":"Palleri","year":"2024","journal-title":"Neonatology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/INF.0000000000004022","article-title":"Epidemiologic Changes of Neonatal Early-Onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong","volume":"42","author":"Wang","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/1471-0528.17279","article-title":"Incidence of Neonatal Sepsis after Universal Antenatal Culture-based Screening of Group B Streptococcus and Intrapartum Antibiotics: A Multicentre Retrospective Cohort Study","volume":"130","author":"Chan","year":"2023","journal-title":"Int. J. Obstet. Gynaecol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1080\/14767058.2017.1300649","article-title":"Prevention of Early Onset Group B Streptococcal Disease by Universal Antenatal Culture-Based Screening in All Public Hospitals in Hong Kong","volume":"31","author":"Ma","year":"2018","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/j.1440-1754.2009.01541.x","article-title":"Letters to the Editor","volume":"45","author":"Khan","year":"2009","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Pompilio, A., Di Bonaventura, G., and Gherardi, G. (2019). An Overview on Streptococcus Bovis\/Streptococcus Equinus Complex Isolates: Identification to the Species\/Subspecies Level and Antibiotic Resistance. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20030480"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1128\/JCM.05635-11","article-title":"A Longitudinal Case Series Description of Meningitis Due to Streptococcus Gallolyticus Subsp. Pasteurianus in Infants","volume":"50","author":"Klatte","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.chom.2019.11.008","article-title":"Baby\u2019s First Bacteria: Discriminating Colonizing Commensals from Pathogens","volume":"26","author":"Xing","year":"2019","journal-title":"Cell Host Microbe"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/01.inf.0000176735.20008.cd","article-title":"Coagulase-Negative Staphylococcal Sepsis in Neonates: Association Between Antibiotic Resistance, Biofilm Formation and the Host Inflammatory Response","volume":"24","author":"Klingenberg","year":"2005","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Fran\u00e7a, A. (2023). The Role of Coagulase-Negative Staphylococci Biofilms on Late-Onset Sepsis: Current Challenges and Emerging Diagnostics and Therapies. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030554"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Findlay, E., Cullen, E., and Abernethy, C. (2022). 297 A Study to Assess the Length of Hospital Stay in Pre-Term Babies under 34 Weeks Gestation. Proceedings of the British Association of Perinatal Medicine and Neonatal Society, Royal College of Paediatrics and Child Health.","DOI":"10.1136\/archdischild-2022-rcpch.221"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"397","DOI":"10.5005\/jp-journals-11002-0051","article-title":"Prevalence of Gram-Negative Bacteria in Maternal Cervical Secretions: A Systematic Review and Meta-Analysis","volume":"1","author":"Maheshwari","year":"2022","journal-title":"Newborn"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1542\/peds.2005-0552","article-title":"Seventy-Five Years of Neonatal Sepsis at Yale: 1928\u20132003","volume":"116","author":"Bizzarro","year":"2005","journal-title":"Pediatrics"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1007\/s10096-021-04211-8","article-title":"A Decade of Neonatal Sepsis Caused by Gram-Negative Bacilli-a Retrospective Matched Cohort Study","volume":"40","author":"Nordberg","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"F549","DOI":"10.1136\/archdischild-2012-303540","article-title":"Managing and Preventing Outbreaks of Gram-Negative Infections in UK Neonatal Units","volume":"98","author":"Anthony","year":"2013","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"G411","DOI":"10.1152\/ajpgi.00399.2020","article-title":"Dynamics of the Preterm Gut Microbiome in Health and Disease","volume":"320","author":"Cuna","year":"2021","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Lee, C.-C., Feng, Y., Yeh, Y.-M., Lien, R., Chen, C.-L., Zhou, Y.-L., and Chiu, C.-H. (2021). Gut Dysbiosis, Bacterial Colonization and Translocation, and Neonatal Sepsis in Very-Low-Birth-Weight Preterm Infants. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.746111"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/ANC.0000000000000220","article-title":"Potential NICU Environmental Influences on the Neonate\u2019s Microbiome: A Systematic Review","volume":"15","author":"Hartz","year":"2015","journal-title":"Adv. Neonatal Care"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Mulinge, M.M., Mwanza, S.S., Kabahweza, H.M., Wamalwa, D.C., and Nduati, R.W. (2023). The Impact of Neonatal Intensive Care Unit Antibiotics on Gut Bacterial Microbiota of Preterm Infants: A Systematic Review. Front. Microbiomes, 2.","DOI":"10.3389\/frmbi.2023.1180565"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1093\/cid\/ciu084","article-title":"Sepsis from the Gut: The Enteric Habitat of Bacteria That Cause Late-Onset Neonatal Bloodstream Infections","volume":"58","author":"Carl","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Niu, X., Daniel, S., Kumar, D., Ding, E.Y., Savani, R.C., Koh, A.Y., and Mirpuri, J. (2020). Transient Neonatal Antibiotic Exposure Increases Susceptibility to Late-Onset Sepsis Driven by Microbiota-Dependent Suppression of Type 3 Innate Lymphoid Cells. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-69797-z"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.clp.2010.05.006","article-title":"New Concepts of Microbial Translocation in the Neonatal Intestine: Mechanisms and Prevention","volume":"37","author":"Sherman","year":"2010","journal-title":"Clin. Perinatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"eadg5562","DOI":"10.1126\/scitranslmed.adg5562","article-title":"Gut Pathogen Colonization Precedes Bloodstream Infection in the Neonatal Intensive Care Unit","volume":"15","author":"Schwartz","year":"2023","journal-title":"Sci. Transl. Med."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Dermitzaki, N., Baltogianni, M., Tsekoura, E., and Giapros, V. (2024). Invasive Candida Infections in Neonatal Intensive Care Units: Risk Factors and New Insights in Prevention. Pathogens, 13.","DOI":"10.20944\/preprints202407.0540.v1"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"105394","DOI":"10.1016\/j.earlhumdev.2021.105394","article-title":"Healthcare-Associated Infections in High-Risk Neonates: Temporal Trends in a National Surveillance System","volume":"158","author":"Menezes","year":"2021","journal-title":"Early Hum. Dev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/1469-0691.12040","article-title":"ESCMID Guideline for the Diagnosis and Management of Candida Diseases 2012: Prevention and Management of Invasive Infections in Neonates and Children Caused by Candida spp.","volume":"18","author":"Hope","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/QCO.0b013e328343614e","article-title":"Amphotericin B in Neonates: Deoxycholate or Lipid Formulation as First-Line Therapy - Is There a \u201cright\u201d Choice?","volume":"24","author":"Turkova","year":"2011","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1542\/peds.106.4.712","article-title":"When to Suspect Fungal Infection in Neonates: A Clinical Comparison of Candida Albicans and Candida Parapsilosis Fungemia with Coagulase-Negative Staphylococcal Bacteremia","volume":"106","author":"Benjamin","year":"2000","journal-title":"Pediatrics"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jpeds.2012.01.053","article-title":"Empiric Antifungal Therapy and Outcomes in Extremely Low Birth Weight Infants with Invasive Candidiasis","volume":"161","author":"Greenberg","year":"2012","journal-title":"J. Pediatr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/j.1440-1754.2012.02543.x","article-title":"Chemoprophylaxis of Neonatal Fungal Infections in Very Low Birthweight Infants: Efficacy and Safety of Fluconazole and Nystatin","volume":"48","author":"Blyth","year":"2012","journal-title":"J. Paediatr. Child. Health"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Rundjan, L., Wahyuningsih, R., Oeswadi, C.A., Marsogi, M., and Purnamasari, A. (2020). Oral Nystatin Prophylaxis to Prevent Systemic Fungal Infection in Very Low Birth Weight Preterm Infants: A Randomized Controlled Trial. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02074-0"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Barcellini, L., Bresesti, I., and Folgori, L. (2023). Neglected Populations Not to Be Forgotten: Tackling Antimicrobial Resistance in Neonatal Infections. Antibiotics, 12.","DOI":"10.3390\/antibiotics12121688"},{"key":"ref_69","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":"Yusef","year":"2018","journal-title":"Pediatr. Neonatol."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Thomas, R., Ondongo-Ezhet, C., Motsoaledi, N., Sharland, M., Clements, M., and Velaphi, S. (2022). Incidence and All-Cause Mortality Rates in Neonates Infected With Carbapenem Resistant Organisms. Front. Trop. Dis., 3.","DOI":"10.3389\/fitd.2022.832011"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e322","DOI":"10.1542\/peds.2013-1248","article-title":"Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU","volume":"133","author":"Tsai","year":"2014","journal-title":"Pediatrics"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1542\/peds.2005-2677","article-title":"National Institute for Child Health and Human Development Neonatal Research Network The Association of Third-Generation Cephalosporin Use and Invasive Candidiasis in Extremely Low Birth-Weight Infants","volume":"118","author":"Cotten","year":"2006","journal-title":"Pediatrics"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3345\/kjp.2013.56.2.68","article-title":"The Control of Invasive Candida Infection in Very Low Birth Weight Infants by Reduction in the Use of 3rd Generation Cephalosporin","volume":"56","author":"Chang","year":"2013","journal-title":"Korean J. Pediatr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1185\/03007995.2010.487799","article-title":"Challenging Issues in Neonatal Candidiasis","volume":"26","author":"Kaufman","year":"2010","journal-title":"Curr. Med. Res. 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