Bacterial and fungal pathogens causing neonatal sepsis and associated antimicrobial resistance in South African neonatal units-a systematic review.

Background: Pathogens causing neonatal sepsis have developed resistance to antimicrobial treatment, resulting in the convergence of two public health issues; neonatal mortality and antimicrobial resistance. There are a few published studies presenting data from South Africa regarding neonatal sepsis pathogen and resistance profiles. Methods: We conducted a systematic review of bacterial and fungal neonatal sepsis pathogens and antimicrobial resistance profiles from 2005 to 2022. Results: Nine studies were included from 1235 screened. Most studies were from two provinces in South Africa and were conducted at academic hospitals. A single study included data collected nationally. Significant heterogeneity was noted, precluding the value of conducting a formal meta-analysis. There was significant variability in prevalence of pathogens, dependent on whether studies included coagulase negative Staphylococci (CoNS) or not. Studies that included CoNs reported higher prevalence for Gram-positive organisms compared with Gram-negative organisms versus studies that did not include CoNS. A higher proportion of Gram negatives compared with Gram positives and fungi was noted. Consistently low susceptibility to WHO first line empiric therapy was reported in most studies and low susceptibility to second line therapy reported in some studies. Seven studies reported mortality, which ranged from 15.6% to 46.3%. Conclusion: The prevalence of pathogens causing neonatal sepsis in South Africa are consistent with those on the WHO list of priority bacterial and fungal pathogens. A high percentage resistance to WHO first and second line treatment is noted and emphasizes the importance of country specific surveillance for neonatal sepsis.