{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:28:01Z","timestamp":1791412081867,"version":"4.3.3"},"reference-count":84,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"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>Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly among preterm and low-birth-weight infants and in low- and middle-income countries. This burden has intensified with the global increase in multidrug-resistant (MDR) bacteria, especially in neonatal intensive care units, where prolonged hospitalization, invasive interventions, and exposure to broad-spectrum antibiotics promote colonization, transmission, and invasive infection. In this narrative review, we explore the epidemiology and microbiological characteristics of MDR bacterial infections in newborns, alongside their associated risk factors, diagnostic challenges, treatment outcomes, and prevention strategies. Across different settings, Gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, account for a substantial proportion of severe neonatal infections, whereas methicillin-resistant Staphylococcus aureus remains important in selected units. The risk of MDR infection is driven by a complex interplay of factors, ranging from maternal and perinatal exposures to the inherent immunological vulnerability of newborns, hospital-based transmission, antibiotic selection pressure, and structural deficiencies in healthcare infrastructure. Diagnosis remains challenging because clinical presentations are nonspecific and culture-based methods are constrained by low blood volumes, prior antimicrobial exposure, and delayed turnaround times. Treatment is increasingly complicated due to resistance to standard empirical regimens, substantial regional variation in susceptibility profiles, and limited neonatal pharmacokinetic and safety data for reserve agents. Current evidence mainly supports surveillance-informed empirical therapy, susceptibility-guided treatment adjustment, antimicrobial stewardship, and strict infection prevention measures. Future progress will require neonatal-specific clinical trials, harmonized surveillance systems, stronger molecular epidemiology, and more equitable access to microbiological diagnostics and effective treatment.<\/jats:p>","DOI":"10.3390\/pathogens15050469","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:09:33Z","timestamp":1777388973000},"page":"469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Neonatal Infections Caused by Multidrug-Resistant Bacteria: An Analysis of Prevalence, Risk Factors, and Therapeutic Implications\u2014A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5166-1970","authenticated-orcid":false,"given":"Elena-Teona","family":"Co\u0219ovanu","sequence":"first","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora Ana","family":"Balan","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1766-8060","authenticated-orcid":false,"given":"Eric-Oliviu","family":"Co\u0219ovanu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5420-9608","authenticated-orcid":false,"given":"Silvia","family":"Ionescu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1510-3398","authenticated-orcid":false,"given":"Costin","family":"Damian","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1239-8058","authenticated-orcid":false,"given":"Antoneta Dacia","family":"Petroaie","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena-Adorata","family":"Coman","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6530-6874","authenticated-orcid":false,"given":"Mihaela","family":"Grigore","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"\u201cCuza-Vod\u0103\u201d Clinical Hospital of Obstetrics and Gynecology, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0979-0200","authenticated-orcid":false,"given":"Demetra","family":"Socolov","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"\u201cCuza-Vod\u0103\u201d Clinical Hospital of Obstetrics and Gynecology, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2875-8991","authenticated-orcid":false,"given":"Raluca Anca","family":"Balan","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-3982","authenticated-orcid":false,"given":"Luminita Smaranda","family":"Iancu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina Draga","family":"C\u0103runtu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1811-7923","authenticated-orcid":false,"given":"Ramona Gabriela","family":"Ursu","sequence":"additional","affiliation":[{"name":"\u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"\u201cCuza-Vod\u0103\u201d Clinical Hospital of Obstetrics and Gynecology, 700038 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6264980","DOI":"10.1155\/2024\/6264980","article-title":"Microbial Pattern of Neonatal Sepsis in the Neonatal Intensive Care Unit of Dr. Ramelan Navy Central Hospital","volume":"2024","author":"Miranda","year":"2024","journal-title":"Int. J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107035","DOI":"10.1016\/j.ijid.2024.107035","article-title":"Carriage of Antimicrobial-Resistant Enterobacterales among Pregnant Women and Newborns in Amhara, Ethiopia","volume":"143","author":"Amsalu","year":"2024","journal-title":"Int. J. Infect. 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