More than four in ten newborns treated empirically for suspected bloodstream infections at a zonal referral hospital in northern Tanzania did not receive appropriate first-line antimicrobial therapy, according to a cross-sectional study of 344 neonates published in BMC Microbiology. The researchers found that 198 neonates, or 57.6 percent, received empirical treatment that culture and sensitivity testing later judged appropriate, while 113, or 32.8 percent, required escalation of the initial regimen.
The study was conducted at a zonal referral hospital in Northern Tanzania among 344 neonates with suspected bloodstream infections, and 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.
Most of the enrolled neonates were male, 179 of 344, or 52.0 percent, and 174, or 50.6 percent, were born at term. Gram-negative bacteria predominated among the isolates, with Escherichia coli accounting for 46 cases, or 13.4 percent. Among Gram-positive organisms, coagulase-negative staphylococci were the most frequent, appearing in 108 cases, or 31.3 percent. Coagulase-negative staphylococci were the most frequent Gram-positive organisms in this study, appearing in 108 cases, or 31.3 percent.
Resistance patterns reported in the study give cause for concern. The authors observed a high level of resistance to ampicillin and ceftriaxone, two agents widely used in neonatal units, whereas resistance to meropenem, a carbapenem reserved for severe infections, remained lower. The authors observed a high level of resistance to ampicillin and ceftriaxone, whereas resistance to meropenem was lower.
Univariate and multivariable logistic regression analysis was performed to identify factors associated with antimicrobial resistance, and results were reported using odds ratios with 95 percent confidence intervals, with statistical significance considered at p values below 0.05. In the adjusted analysis, three factors emerged as independently associated with antimicrobial resistance. Neonates born before 32 weeks of gestation had roughly twice the odds of resistance, with an adjusted odds ratio of 2.08 and a confidence interval spanning 1.11 to 3.89 and a p value of 0.021.
Birth weight below 1.5 kilograms was similarly linked to resistance, with an adjusted odds ratio of 2.19, a 95 percent confidence interval of 1.12 to 4.27, and a p value of 0.022. Comorbidity, meaning the presence of additional medical conditions alongside the suspected infection, carried an adjusted odds ratio of 2.32 with a confidence interval of 1.09 to 4.93 and a p value of 0.029. Because these estimates come from a single hospital-based cross-sectional study, they describe associations at one point in time rather than proven causal effects, and the confidence intervals indicate some statistical uncertainty around each estimate.
The authors conclude that antimicrobial resistance was high among neonates with suspected bloodstream infections, particularly among Gram-positive organisms, and that this pattern highlights the need for stronger antimicrobial stewardship, better diagnostics, and evidence-based treatment. The authors conclude that this pattern highlights the need for stronger antimicrobial stewardship, better diagnostics, and evidence-based treatment.
The article was published open access on 4 November 2026 in BMC Microbiology. In the adjusted analysis, gestational age below 32 weeks, birth weight below 1.5 kilograms, and comorbidity were independently associated with antimicrobial resistance.
Subject of Research: Antimicrobial resistance and appropriateness of empirical treatment in neonatal bloodstream infections at a Tanzanian referral hospital
Article Title: Appropriateness of empirical treatments and antimicrobial resistance among neonate with blood stream infections. A cross-sectional study at KCMC hospital, Tanzania
Article References: Benjamin, A., Issangya, E. T., Shayo, A., kajeguka, D. C., & Mkumbaye, S. S. (2026). Appropriateness of empirical treatments and antimicrobial resistance among neonate with blood stream infections. A cross-sectional study at KCMC hospital, Tanzania. BMC Microbiology. https://doi.org/10.1186/s12866-026-05882-z
Image Credits: AI Generated
DOI: 10.1186/s12866-026-05882-z
Keywords: neonatal sepsis, bloodstream infections, antimicrobial resistance, empirical therapy, Tanzania, cross-sectional study, Escherichia coli, coagulase-negative staphylococci, ceftriaxone resistance, meropenem, stewardship, low birth weight
News Source: Harold Sullivan. (November 4, 2026). Antimicrobial resistance complicates neonatal sepsis care at Tanzanian referral hospital. Scienmag.
