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Antibiotics
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Neonatal Infection: Antibiotics for Prevention and Treatment
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Neonatal Infection: Antibiotics for Prevention and Treatment

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: 31 July 2026 | Viewed by 7272

Special Issue Editors

Prof. Dr. Cinzia Auriti

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Guest Editor
Departmental Faculty of Medicine, Saint Camillus International University for Health and Medical Sciences (Unicamillus), Via S. Alessandro 8, 00131 Rome, Italy
Interests: neonatology; neonatal medicine; neonatal sepsis; neonatal resuscitation; neonatal screening
Dr. Maria Paola Ronchetti

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Guest Editor
Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
Interests: pregnancy and viral infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Infections, particularly bacterial sepsis, represent a leading cause of death and healthcare resource consumption across all age groups. Despite lower mortality rates in infants and children over the past two decades, severe sepsis remains a common cause of death. Premature newborns are particularly vulnerable due to their immature immune systems and the necessity for invasive treatments. Timely antibiotic administration is critical in reducing sepsis mortality in newborns and children. However, diagnostic complexities often result in excessive antibiotic use, leading to the emergence of antibiotic-resistant microorganisms. The tracking of changes in neonatal sepsis prevention and treatment is also hindered by inconsistent definitions that make it difficult to compare data between neonatal centers and between different countries. The diagnosis of organ dysfunction in newborns and preterm infants presents significant challenges due to the absence of baseline values that reflect the temporary alterations associated with the transition from intrauterine to extrauterine life. This complexity further complicates the identification of sepsis in this population. Positive blood cultures, the gold-standard diagnosis method, only confirm infection in 9% of neonates with sepsis.

This Special Issue will address neonatal infections, including bacterial and fungal sepsis, epidemiology, definitions, severity scores, antibiotic use, biomarkers, new antibiotics, antibiotic stewardship, multi-resistance in microorganisms, and challenging infections.

Prof. Dr. Cinzia Auriti
Dr. Maria Paola Ronchetti
Guest Editors

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 infections
  • neonatal sepsis
  • sepsis definition
  • antibiotics in newborns
  • antibiotic stewardship
  • sepsis biomarkers
  • sepsis diagnosis in newborns
  • epidemiology of neonatal infections
  • fungal invasive infections

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Published Papers (6 papers)

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Research

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12 pages, 938 KB  
Article
Restricting C-Reactive Protein Use in Early-Onset Neonatal Sepsis Reduces Unnecessary Antibiotic Exposure
by Valeria Capone, Sophie Venturelli, Eleonora Cresta, Francesca Miselli, Martina Buttera, Licia Lugli, Eugenio Spaggiari and Alberto Berardi
Antibiotics 2026, 15(3), 308; https://doi.org/10.3390/antibiotics15030308 - 18 Mar 2026
Viewed by 695
Abstract
Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform [...] Read more.
Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform local practice. Methods: Retrospective analysis at a level III center assessing the impact of discontinuing routine C-reactive protein (CRP) testing for suspected early-onset sepsis (EOS). Laboratory use, antibiotic therapy, and outcomes in neonates of all gestational ages were compared before (2021–2022) and after (2024–2025) the policy change. Results: A total of 638 neonates were included (period 1, n = 348; period 2, n = 290). CRP testing decreased markedly (218/348 in period 1 vs. 40/290 in period 2; p < 0.001), alongside a significant reduction in the number of complete blood counts performed (285/348 vs. 214/290; p = 0.02). Concurrently, both the proportion of short antibiotic courses (≤48 h) initiated within the first 3 days of life (98/181 vs. 88/133) and the median duration of antibiotic therapy (48.0 h vs. 40.0 h; p < 0.001) decreased without worsening outcomes. The duration of antibiotic therapy was even shorter in infants born before 34 weeks’ gestation (48.0 h vs. 37.5 h; p < 0.001). Conclusions: Restricting the use of CRP in the evaluation of EOS was associated with a reduction in unnecessary antibiotic exposure. This strategy may be considered a core component of neonatal antibiotic stewardship programs. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
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11 pages, 228 KB  
Article
Use of RESERVE-Antibiotics in Newborns: Clinical Experience of Two NICUs in the Metropolitan Area of Palermo
by Veronica Notarbartolo, Deborah Bacile, Bintu Ayla Badiane, Agnese Lo Leggio, Vita Maria Angileri, Vincenzo Duca and Mario Giuffré
Antibiotics 2026, 15(2), 231; https://doi.org/10.3390/antibiotics15020231 - 21 Feb 2026
Viewed by 769
Abstract
Background: The increasingly indiscriminate use of antibiotic therapy in the neonatal period has led to the emergence of multidrug-resistant organisms (MDROs), which are responsible for sepsis that is increasingly difficult to treat and associated with high morbidity and mortality. Increasingly frequently, in [...] Read more.
Background: The increasingly indiscriminate use of antibiotic therapy in the neonatal period has led to the emergence of multidrug-resistant organisms (MDROs), which are responsible for sepsis that is increasingly difficult to treat and associated with high morbidity and mortality. Increasingly frequently, in neonatal intensive care units (NICUs), it is necessary to use last-generation antibiotics belonging to the RESERVE group according to the current classification of the World Health Organization (WHO). Methods: Among these drugs, ceftazidime-avibactam, ceftolozane-tazobactam and meropenem-vaborbactam are increasingly used in infections caused by Enterobacterales (i.e., E. cloacae complex, Klebsiella spp.), which are often responsible for late-onset sepsis (LOS) in newborns, especially in preterms. Results: Here, we present the experience of four newborn patients in the city of Palermo, treated over a period of 3 years. Conclusions: The comparison between different diagnostic–therapeutic management approaches and a review of the most recent literature can contribute to identifying more standardized pharmacological schemes, especially in the neonatal period, where scientific evidence about this topic is still very limited. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)

Review

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17 pages, 304 KB  
Review
Antibiotic Prophylaxis and Treatment of Neonatal Group B Streptococcus Disease in the Era of Antimicrobial Resistance
by Chryssoula Tzialla, Serena Salomè, Vito Mondì, Vincenzo Salvo and Alberto Berardi
Antibiotics 2026, 15(3), 306; https://doi.org/10.3390/antibiotics15030306 - 18 Mar 2026
Viewed by 1046
Abstract
Group B Streptococcus (GBS) remains a major cause of early- and late-onset neonatal sepsis worldwide, despite the widespread use of intrapartum antibiotic prophylaxis (IAP). β-lactam antibiotics, including penicillin G and ampicillin, remain the cornerstone of both GBS prophylaxis and neonatal treatment, supported by [...] Read more.
Group B Streptococcus (GBS) remains a major cause of early- and late-onset neonatal sepsis worldwide, despite the widespread use of intrapartum antibiotic prophylaxis (IAP). β-lactam antibiotics, including penicillin G and ampicillin, remain the cornerstone of both GBS prophylaxis and neonatal treatment, supported by sustained susceptibility, favorable pharmacokinetics, and extensive clinical experience. However, increasing global resistance to macrolides and lincosamides has markedly reduced the reliability of clindamycin and erythromycin, which are commonly used as second-line agents in women with severe penicillin allergy. This narrative review summarizes current evidence on antibiotic strategies for the prevention and treatment of neonatal GBS disease, with a particular focus on antimicrobial resistance patterns and their clinical implications. Available surveillance data demonstrate substantial geographic variability in resistance but consistently low resistance to β-lactams and vancomycin. These trends have expanded the role of vancomycin in IAP for women with high-risk β-lactam allergy and in neonatal treatment when first-line agents are contraindicated. Alternative agents such as linezolid and teicoplanin exhibit activity against GBS, but their use remains limited by sparse neonatal data and pharmacokinetic variability. Ongoing antimicrobial surveillance, susceptibility-guided therapy, and stewardship initiatives are essential to preserve effective GBS prevention and treatment strategies. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
17 pages, 681 KB  
Review
Treatment of Syphilis in Pregnancy and Congenital Syphilis: Current Evidence, Challenges, and Future Directions
by Serena Salomè and Chryssoula Tzialla
Antibiotics 2026, 15(3), 305; https://doi.org/10.3390/antibiotics15030305 - 18 Mar 2026
Viewed by 1975
Abstract
Syphilis remains a global public health concern, with maternal infection posing a substantial risk for congenital syphilis, a preventable condition associated with severe morbidity and mortality. Penicillin, particularly benzathine penicillin G, remains the cornerstone of treatment and the only therapy with proven efficacy [...] Read more.
Syphilis remains a global public health concern, with maternal infection posing a substantial risk for congenital syphilis, a preventable condition associated with severe morbidity and mortality. Penicillin, particularly benzathine penicillin G, remains the cornerstone of treatment and the only therapy with proven efficacy in preventing vertical transmission during pregnancy. However, recurrent global shortages, limited manufacturing capacity, mislabeling of penicillin allergy, and the absence of validated alternative regimens for pregnant women and neonates threaten progress toward elimination goals. This review summarizes current evidence on the treatment of syphilis in pregnancy and congenital syphilis, highlighting the established maternal and neonatal regimens, diagnostic and therapeutic challenges, and clinical consequences of delayed or inadequate treatment. We examine the scope and drivers of benzathine penicillin G shortages, the overestimation of penicillin allergy and its impact on care, and the role of neonatal management when maternal therapy is suboptimal. Emerging data on alternative antimicrobial agents, including cephalosporins, tetracyclines, lipoglycopeptides, and novel compounds are discussed considering recent advances in Treponema pallidum culture and susceptibility testing. While several non-penicillin agents show promise for non-pregnant populations, robust evidence supporting their use during pregnancy and for the prevention of congenital syphilis is lacking. Addressing these gaps through coordinated supply chain strategies, guideline harmonization, and targeted clinical research is essential to ensure resilient and equitable syphilis control and advance global efforts toward the elimination of congenital syphilis. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
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12 pages, 340 KB  
Review
The Angel in the Marble: Antibiotic Duration in the Neonatal Intensive Care Unit
by Joseph B. Cantey and Dalyn B. Guinn
Antibiotics 2026, 15(2), 228; https://doi.org/10.3390/antibiotics15020228 - 20 Feb 2026
Viewed by 1156
Abstract
Antimicrobial stewardship in the neonatal intensive care unit is a critically important tool to optimize clinical outcomes. The ideal duration of antimicrobial treatment is a key area that contains many knowledge gaps. This narrative review has three aims. One, to highlight the existing [...] Read more.
Antimicrobial stewardship in the neonatal intensive care unit is a critically important tool to optimize clinical outcomes. The ideal duration of antimicrobial treatment is a key area that contains many knowledge gaps. This narrative review has three aims. One, to highlight the existing evidence for empiric and definitive antibiotic treatment durations for infants; two, to focus on clinical situations where further studies are needed; and three, to propose a rational, goal-based approach to clinical studies that provide for infant safety as shorter treatment durations are investigated. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
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15 pages, 1351 KB  
Review
A Rare Intruder: Neonatal Meningoencephalitis by Edwardsiella tarda Requiring Systemic and Intrathecal Antibiotics and Repeated Neurosurgery
by Domenico Umberto De Rose, Ludovica Martini, Francesca Campi, Daniela Longo, Alessia Guarnera, Giulia Lucignani, Marta Conti, Alessandra Santisi, Carlotta Ginevra Nucci, Giacomo Esposito, Lorenza Romani, Paola Bernaschi, Bianca Maria Goffredo, Gianfranco Scarpelli, Laura Lancella, Andrea Dotta and Maria Paola Ronchetti
Antibiotics 2026, 15(1), 59; https://doi.org/10.3390/antibiotics15010059 - 5 Jan 2026
Viewed by 914
Abstract
Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal [...] Read more.
Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes. Full article
(This article belongs to the Special Issue Neonatal Infection: Antibiotics for Prevention and Treatment)
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