Appropriateness of empirical treatments and antimicrobial resistance among neonate with blood stream infections. A cross-sectional study at KCMC hospital, Tanzania

Neonatal bloodstream infections (BSIs) remain a major cause of morbidity and mortality, particularly in low- and middle-income countries. Rising antimicrobial resistance (AMR) increasingly complicates neonatal sepsis management and threatens empirical antimicrobial therapy. This study assessed the appropriateness of empirical antimicrobial therapy, characterized AMR patterns among neonates with suspected BSIs, and identified factors associated with antimicrobial resistance. A hospital-based cross-sectional study was conducted among 344 neonates with suspected bloodstream infections at a zonal referral hospital in Northern Tanzania. Sociodemographic and clinical information were collected using a standardized, interviewer-administered questionnaire. Blood samples were collected aseptically and processed using standard microbiological procedures for bacterial isolation and identification. The appropriateness of empirical antimicrobial therapy was evaluated based on culture and sensitivity results. Univariate and multivariable logistic regression analysis was performed to identify factors associated with antimicrobial resistance, and results were reported using odds ratios (OR) with 95% confidence intervals (CI). Statistical significance was considered at p < 0.05. A total of 344 neonates with suspected bloodstream infections were included. Most were male 179 (52.0%), and 174 (50.6%) were born at term. Appropriate empirical antimicrobial therapy was administered to 198 (57.6%), while 113 (32.8%) required escalation of empirical antimicrobial therapy. Gram-negative bacteria predominated among the isolates, with Escherichia coli 46 (13.4%), while 108 (31.3%) coagulase-negative staphylococci were the most frequent Gram-positive organisms. High level of resistance was observed to ampicillin and ceftriaxone, whereas resistance to meropenem was lower. In adjusted analysis, gestational age < 32 weeks (AOR = 2.08, 95% CI: 1.11–3.89, p = 0.021), birth weight < 1.5 kg (AOR = 2.19, 95% CI: 1.12–4.27, p = 0.022), and comorbidity (AOR = 2.32, 95% CI: 1.09–4.93, p = 0.029) were independently associated with antimicrobial resistance. Antimicrobial resistance was high among neonates with suspected bloodstream infections, particularly among Gram-positive organisms, highlighting the need for stronger stewardship, diagnostics, and evidence-based treatment.