Bacterial Profile and Antimicrobial Susceptibility Patterns among Neonates with Suspected Sepsis at a Tertiary Hospital (ACSH) in Tigray, Northern Ethiopia: A Prospective Observational Study

<title>Abstract</title> <p>Background Neonatal sepsis remains a major cause of morbidity and mortality worldwide, particularly in low-resource and post-conflict settings. The increasing burden of antimicrobial resistance (AMR) has substantially reduced the effectiveness of empirical antibiotic therapy. Local evidence on bacterial pathogens and antimicrobial susceptibility patterns is essential for optimizing clinical management and guiding institutional treatment protocols. Objective To determine the bacterial profile and antimicrobial susceptibility patterns among neonates with suspected sepsis admitted to the Neonatal Intensive Care Unit (NICU) of Ayder Comprehensive Specialized Hospital (ACSH), Tigray Region, Northern Ethiopia. Methods A hospital-based prospective observational study was conducted in the NICU of ACSH from January 1 to December 31, 2025. Consecutive neonates with clinically suspected sepsis were enrolled. Blood cultures were obtained under aseptic conditions before initiation of antibiotic therapy. Bacterial isolates were identified using standard microbiological methods, and antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using IBM SPSS Statistics version 27. Results Among 526 neonates with suspected sepsis, 132 (25.1%) had culture-confirmed sepsis, yielding 137 bacterial isolates. Gram-negative bacteria predominated (69.3%), with Klebsiella species (26.3%) and Enterobacter cloacae (19.0%) being the most frequently isolated pathogens. Coagulase-negative Staphylococci (CoNS) (16.0%) were the leading Gram-positive isolates. High resistance rates were observed against commonly used empirical antibiotics, including ampicillin (96.2%), ciprofloxacin (63.2%), and Ceftazidime (74.7%). The highest susceptibility was demonstrated to Amikacin, followed by Meropenem and levofloxacin. Multidrug-resistant organisms accounted for 43.3% of isolates. Early-onset neonatal sepsis represented 60.6% of confirmed cases, while the overall mortality rate was 13.5%. Conclusion Gram-negative organisms were the predominant cause of neonatal sepsis and exhibited extensive resistance to commonly prescribed first-line antibiotics. These findings indicate that current empirical treatment regimens require urgent review. Strengthening antimicrobial stewardship, infection prevention strategies, and continuous microbiological surveillance is essential to improve neonatal outcomes in this post-conflict setting health care provision center.</p>