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Antimicrobial resistance in UK neonatal units: neonIN infection surveillance network
  1. Benjamin Cailes1,
  2. Christina Kortsalioudaki1,
  3. Jim Buttery2,
  4. Santosh Pattnayak3,
  5. Anne Greenough4,
  6. Jean Matthes5,
  7. Alison Bedford Russell6,
  8. Nigel Kennea7,
  9. Paul T Heath1
  10. on behalf of the neonIN network
  1. 1 Paediatric Infectious Diseases Research Group, St George’s University of London, London, UK
  2. 2 Department of Infection and Immunity, Monash Children’s, Monash Medical Centre, Clayton, Australia
  3. 3 Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Gillingham, UK
  4. 4 Department of Women and Children’s Health, Kings College London, Kings College Hospital, London, UK
  5. 5 Singleton Hospital NICU, Singleton Hospital, Swansea, UK
  6. 6 Birmingham Women’s Hospital NICU, Birmingham Women’s NHS Foundation Trust, Birmingham, UK
  7. 7 St George’s University NHS Foundation Trust, London, UK
  1. Correspondence to Dr Benjamin Cailes, Paediatric Infectious Diseases Research Group, St George’s University of London, Cranmer Terrace, London, SW11 0RU, UK; bcailes{at}


Objective To define the susceptibilities of the common causative pathogens of neonatal sepsis in the UK.

Design Retrospective analysis of the prospectively collected neonIN infection surveillance network data between 2005 and 2014.

Setting 30 neonatal units in the UK.

Patients Newborns admitted to participating neonatal units who return a positive blood, cerebrospinal fluid or urine culture and are treated with at least 5 days of appropriate antibiotics.

Results 1568 isolates with recorded antimicrobial data were collected including 328 early-onset sepsis (EOS) isolates and 1240 late-onset sepsis (LOS) isolates. The majority of EOS pathogens (>92%) were susceptible to the four empirical commonly used antimicrobial combinations (eg, 93% for benzylpenicillin/gentamicin), while LOS pathogens demonstrated higher levels of resistance (eg, 89% for flucloxacillin/gentamicin). Among infants<1500 g and <32 weeks gestation, an amoxicillin/gentamicin combination demonstrated a trend towards improved coverage of EOS isolates than benzylpenicillin/gentamicin (93% vs 86%, p=0.211).

Conclusions This analysis provides insights into the patterns of antimicrobial resistance among UK neonatal pathogens. These data will inform areas of future research and can be used to update national evidence-based guidelines on antimicrobial usage.

  • infectious diseases
  • epidemiology
  • neonatology
  • intensive care

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  • Contributors BCC and CK contributed to the design of the analysis, conducted the analysis of the data, drafted the manuscript and revised it according to feedback from coauthors. PTH developed the neonIN network, designed the current analysis and provided critical appraisal as well as final approval of the manuscript. JB, SP, AG, JM, ABR and NK made substantial contributions to the acquisition of data for the analysis, critically revised the manuscript and provided final approval for the version to be submitted. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Ethics approval The neonIN database received ethics approval from the London-Surrey Borders Research Ethics Committee in April 2005 (05/Q0806/34) and again in December 2013 (05/Q0806/34+5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data from this study are available only to members of the neonIN team and may form part of future analyses. Generalised statistics however are freely available on the neonIN website at