Turnaround Time, Culture Positivity, and Antibiotic Resistance in Neonates with Suspected Sepsis in a Ghanaian Tertiary Care Hospital During 2022–2024, Following Operational Research in 2021

We conducted a cross-sectional study using secondary data from 506 neonates with suspected sepsis to assess improvements in turnaround time, bacterial yield, prescription appropriateness, and death rates during 2022 to 2024 at a tertiary military hospital in Accra, Ghana following operational research for the period 2017- 2020. During, 2022-2024, the median turnaround time, was 48 hours for culture-positive cases and five days for culture-negative cases. 28.9% (n=146) of neonates were discharged before culture results were available, including 27 (5.3%) who were later confirmed culture positive. Overall, 15.4% (n=78) were confirmed culture positive, with late-onset sepsis making up 11.7% (n=59). Treatment was changed in 25.4% (n=128) of post-culture cases, with 4.8% (n=24) were culture positive. Gram-positive organisms were predominant 56.5% (n=39), with coagulase-negative Staphylococcus 37.7% (n=26) and Staphylococcus aureus 13.0% (n=9) being the most common; half of these were multidrug-resistant. Gram-negative also made up 43% (n=30), with Klebsiella pneumoniae as the predominant 20.3% (n=14), followed by E coli 10.1% (n=7). High resistance to penicillin were seen among most isolates with 100% of Enterococcus faecalis, 87.5% of S. aureus, and 66.7% of coagulase-negative Staphylococcus. Turnaround time improved in the present study compared to the previous study, culture positivity decreased to 13.6% in 2022-2024 from 29% during 2017-2020, and mortality rates remained about 7% across both periods. Most frequent empirically prescribed antibiotic combinations include gentamicin (4mg/kg/24-36 hourly) and penicillin (50,000units/kg/12 hourly) 63.6% (n=318), penicillin (50,000units/kg/12 hourly) and amikacin (15mg/kg/24 hourly) 8% (n=40), ciprofloxacin (10mg/kg/12 hourly) and piperacillin-tazobactam ( 90mg/kg/8-12 hourly) 7.8% (n=39), and amikacin (15mg/kg/24 hourly) and piperacillin-tazobactam ( 90mg/kg/8-12 hourly) 7.6% (n=38). 4.8% (n=24) out of the culture-positive reports 15.3% (n=77) treatments were changed, while no readmission was recorded after two weeks post-discharge for those discharges without their report. There was a notable decrease in culture positivity rates and a stable mortality rate from 2017 to 2024; significant challenges remain in the management of neonatal sepsis at this military hospital. Reinforcing infection control measures, strengthening antimicrobial stewardship, and maintaining ongoing resistance surveillance are critical to guiding effective empirical therapy and improving neonatal outcomes in this setting.