More and more newborns are entering the world with resistance to standard antibiotics

New data from hospitals in Southeast Asia show that many newborn infections no longer respond to the usual starter antibiotics.

A large multi-country study analyzed 14,804 blood cultures from sick infants and found that the bacteria behind most cases resist the antibiotics that doctors typically reach for first.

The work focuses on neonatal sepsis, a life threatening infection that strikes in the first 28 days of life, and on antimicrobial resistance which means germs can keep growing even when exposed to antibiotics.

It is a problem that slows progress on newborn survival and adds pressure on already crowded nurseries.

Why newborns are resistant to antibiotics

Associate Professor Phoebe C. M. Williams of the University of Sydney led the analysis with the Neonatal sepsis in Southeast Asia and the Pacific collaboration.

Her team examined which microbes show up in newborn bloodstreams and which medicines those microbes ignore.

“Guidelines must be updated to reflect local bacterial profiles and known resistance patterns. Otherwise, mortality rates are only going to keep climbing,” Williams said. 

The core issue is fit. Protocols built from high income country data do not map neatly onto hospitals in Indonesia, the Philippines, Malaysia, Sri Lanka, or Vietnam, where this study pulled its cases.

Key study findings

Across the ten sites, gram negative bacteria dominated bloodstream infections in newborns, not the gram positive organisms often emphasized in older playbooks.

The most common were Klebsiella and Acinetobacter, both known for finding ways around drugs.

The usual antibiotics often failed against Klebsiella, with nearly nine out of ten samples showing resistance. Even stronger drugs, like carbapenems, frequently did not work when Acinetobacter was the cause.

The group also flagged fungi. Nearly one in ten cultures confirmed infections involved Candida species, a reminder that not every life threatening case is bacterial and that mycology capacity matters for fragile infants.

Local data on newborns and antibiotics

Clinicians treating a crashing newborn cannot wait for a lab result that may arrive late or come back negative.

They rely on empirical choices guided by standard texts and national advice, so the starting point must reflect today’s microbes in today’s wards.

The World Health Organization (WHO) still recommends ampicillin with gentamicin as the first line for suspected early onset sepsis in many settings, a sensible guideline when it matches local bugs.

In this study’s hospitals, the pathogens and their resistance patterns have shifted, which means those first steps often fall short.

“It takes about 10 years for a new antibiotic to be trialed and approved for babies. With so few new drug candidates in the first place, we need a significant investment in antibiotic development,” said Michelle Harrison from the School of Public Health, Faculty of Medicine & Health at The University of Sydney (US). 

Resistance worsens care

When a newborn’s first doses do not touch the pathogen, every hour without effective therapy increases risk.

That is why the team points to Enterobacterales such as Klebsiella and E. coli that carry enzymes which break down common drugs and spread across nurseries.

Hospital crowding, prolonged stays for premature infants, and invasive care raise exposure chances.

Many units still struggle to draw adequate blood volumes for cultures, which lowers test sensitivity and masks the true burden of resistant organisms.

The picture that emerges is not uniform across the region, but the direction is clear. Empirical regimens must be recalibrated around contemporary local data rather than imported averages.

Treating newborns resistant to antibiotics

Hospitals can strengthen routine surveillance for both bacteria and fungi and feed those data into treatment charts.

Pharmacy teams can trim unnecessary broad spectrum use, reserving the strongest agents for when they are truly needed.

Lab managers can prioritize rapid blood culture workflows and species level identification where possible. Even small gains in turnaround times can help clinicians move from guesses to targeted therapy sooner.

Nurses and infection prevention staff can keep pushing on basics like hand hygiene, line care, and space management. These steps cut horizontal transmission, which is a steady engine for resistant outbreaks in nurseries.

Solutions for antibiotics resistance

Updating guidelines is essential, but families also need better medicines sized and tested for small bodies.

Many antibiotics lack age appropriate formulations or pediatric labeling, which slows safe use in the very group that needs them.

WHO has issued target product profiles to guide developers toward child friendly formulations and priority pathogens, a practical WHO step that can tighten the pipeline for infants.

Aligning regulators, funders, and manufacturers around those targets can shave years off delays that cost lives.

Regional research networks like NeoSEAP can run pragmatic trials that compare realistic regimens for high resistance settings.

Those results can inform stewardship and give ministries the confidence to update national norms.

Bacteria are not static. When exposed to antibiotics again and again, survivors pass along tricks that make the next generation harder to kill.

Resistance is not a mystery, it is selection. The fix is smarter use, faster diagnostics, and medicines built for the youngest patients.

The study is published in The Lancet Regional Health – Western Pacific.

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