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Antibiotics
Special Issues
Antimicrobial Stewardship in Neonatal Intensive Care
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Antimicrobial Stewardship in Neonatal Intensive Care

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 May 2026 | Viewed by 2283

Special Issue Editor

Dr. Chiara Poggi

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Guest Editor
Neonatal Intensive Care Unit, Department of Mother and Child Care, Careggi University Hospital, 50141 Florence, Italy
Interests: sepsis; newborn; intensive care; biomarkers; antimicrobial stewardship; antibiotic therapy in pediatric infectious diseases

Special Issue Information

Dear Colleagues,

Sepsis is currently one of the main morbidities among newborns, and it is accompanied by a high mortality rate and long-term sequelae. Antimicrobial stewardship in the Neonatal Intensive Care Unit aims to increase the efficacy of antimicrobial treatment, reduce the risk of undesired events related to excessive or inappropriate exposure to antimicrobials, and prevent antimicrobial resistance. The prevalence of multidrug-resistant bacteria has been increasing in Neonatal Intensive Care Units worldwide. However, there are currently no internationally recognized antimicrobial stewardship programs specifically targeted towards the neonatal population, and wide variations in clinical practice are reported.

The aim of this Special Issue is to gather evidence about antimicrobial stewardship strategies in neonatal intensive care and to highlight groundbreaking research in this field. In particular, we are seeking manuscripts that address different aspects of appropriate antimicrobials use, including (but not limited to) strategic empirical treatment of early- and late-onset sepsis in different epidemiological settings; the contributions of molecular diagnostic techniques; stopping rules in term and preterm infants; the duration of antimicrobial treatment; antimicrobials administration modes; strategies for antimicrobial dose optimization; and active microbiological surveillance in Neonatal Intensive Care Units. Submissions focusing on peculiar aspects of neonatology, such as extended/continuous infusion of antimicrobials and therapeutic drug monitoring, are particularly encouraged.

Dr. Chiara Poggi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • neonatal sepsis
  • early onset sepsis
  • late onset sepsis
  • preterm
  • antimicrobial stewardship
  • neonatal intensive care
  • molecular diagnosis
  • stopping rule
  • therapeutic drug monitoring
  • extended antimicrobial infusion
  • continuous antimicrobial infusion
  • microbiological surveillance

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Published Papers (2 papers)

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Research

14 pages, 454 KB  
Article
Risk Factors and Outcomes of Extensively Drug-Resistant Gram-Negative Bacilli in Neonates with Late-Onset Sepsis
by Sanchat Sanchainara, Anucha Thatrimontrichai, Praew Chareesri, Pattima Pakhathirathien, Manapat Praditaukrit, Gunlawadee Maneenil and Supaporn Dissaneevate
Antibiotics 2026, 15(2), 166; https://doi.org/10.3390/antibiotics15020166 - 4 Feb 2026
Viewed by 976
Abstract
Background/Objective: To identify the risks and outcomes of extensively drug-resistant Gram-negative bacilli (XDR-GNB) in neonates. Methods: This retrospective case–control study (1995–2024) included neonates with late-onset sepsis (n = 132) and XDR-GNB bacteremia (n = 26) compared with those without [...] Read more.
Background/Objective: To identify the risks and outcomes of extensively drug-resistant Gram-negative bacilli (XDR-GNB) in neonates. Methods: This retrospective case–control study (1995–2024) included neonates with late-onset sepsis (n = 132) and XDR-GNB bacteremia (n = 26) compared with those without XDR-GNB (n = 106). Results: Median gestational age was 31 weeks and birth weight 1540 g. The prevalence of XDR-GNB was 19.7%. The most common XDR-GNB and non-XDR-GNB pathogens were Acinetobacter baumannii and Klebsiella pneumoniae. Sepsis onset occurred earlier in the XDR-GNB group than in the non-XDR-GNB group (7.0 vs. 12.5 days, p = 0.005). In multivariable analysis using Firth’s penalized likelihood method, the XDR-GNB group was more likely to have gastrointestinal anomalies (adjusted odds ratio 3.81, 95% confidence interval 1.24–12.01, p = 0.02) and history of umbilical arterial catheterization (adjusted odds ratio 3.04, 95% confidence interval 1.21–7.95, p = 0.02) compared to the non-XDR-GNB group. The XDR-GNB group had higher rates of septic shock (50.0% vs. 18.9%, p = 0.002) and inadequate empiric antimicrobial therapy (34.6% vs. 13.2%, p = 0.02). The non-susceptibility rates to third-generation cephalosporins, gentamicin, carbapenems, amikacin, and colistin were 83.3%, 58.3%, 48.1%, 30.4%, and 4.4%, respectively. Conclusions: Empirical colistin treatment is warranted for neonates in high-XDR environments who exhibit septic shock and have specific risk factors, such as gastrointestinal anomalies or the presence of an umbilical arterial catheter. Multimodal interventions, including antimicrobial stewardship programs, have been used to prevent or reduce the incidence of neonatal XDR-GNB sepsis. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Neonatal Intensive Care)
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15 pages, 272 KB  
Article
Early Life Antibiotic Exposure and Intestinal Colonization by Enterobacteriaceae upon Admission to a Neonatal Referral Unit: A Case–Control Study
by Sergio Agudelo-Pérez, Gloria Troncoso, Martha Alvarez-Olmos, Maria Pineda, Adriana Moscote and María Paula Molina Pérez
Antibiotics 2026, 15(2), 123; https://doi.org/10.3390/antibiotics15020123 - 27 Jan 2026
Viewed by 891
Abstract
Background/Objectives: Intestinal colonization by Enterobacteriaceae, including extended-spectrum β-lactamase-producing (ESBL-E) and carbapenemase-producing (E-CPE) strains, is an early marker of multidrug-resistant infections in neonates, particularly those transferred from lower-complexity hospitals. This study aimed to identify factors associated with intestinal Enterobacteriaceae colonization upon admission to a [...] Read more.
Background/Objectives: Intestinal colonization by Enterobacteriaceae, including extended-spectrum β-lactamase-producing (ESBL-E) and carbapenemase-producing (E-CPE) strains, is an early marker of multidrug-resistant infections in neonates, particularly those transferred from lower-complexity hospitals. This study aimed to identify factors associated with intestinal Enterobacteriaceae colonization upon admission to a level IV neonatal referral unit in Colombia, with a focus on prior antibiotic exposure. Methods: We conducted a retrospective case–control study, including all neonates transferred from peripheral hospitals and screened with rectal swabs at admission. Cases were neonates colonized with Enterobacteriaceae, and controls were non-colonized neonates admitted during the same period. Multivariable logistic regression models were used to evaluate three exposure dimensions: prior antibiotic use (yes/no), number of agents, and the WHO AWaRe classification. A secondary analysis was performed to assess the factors associated with ESBL-E and E-CPE colonization. Results: Among the 435 referred neonates, 87 (20.0%) were colonized, predominantly Klebsiella pneumoniae (53.6%) and Escherichia coli (19.5%). Prior antibiotic use (aOR 3.01; 95% CI 1.47–6.37), exposure to two agents (aOR 4.13; 95% CI 1.94–8.89) and use of AWaRe Access antibiotics (aOR 22.2; 95% CI 5.83–101) were strongly associated with colonization. Longer hospitalization and central catheter use were also associated with greater colonization odds, whereas total parenteral nutrition showed a protective association. In the sub-analysis, Access, Watch, and Reserve antibiotics were independently associated with ESBL-E and E-CPE colonization. Conclusions: Among transferred neonates, prior antibiotic exposure, particularly AWaRe-classified agents, showed the strongest association with intestinal colonization by Enterobacteriaceae, including ESBL-E/CPE phenotypes. Strengthening antimicrobial stewardship in referral facilities and implementing risk-based screening at admission may help reduce colonization and limit the spread of resistance. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship in Neonatal Intensive Care)
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