Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit

Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit ANTHON GEORGE MWINGWA, Michael Bokobola, Careen J. Josiah, Elieshiupendo M Niccodem, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8370266/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Acinetobacter spp. bloodstream infections (BSIs) are an emerging cause of neonatal sepsis, yet data from sub-Saharan Africa are scarce. We retrospectively reviewed neonates admitted to the Kilimanjaro Christian Medical Centre Neonatal unit, Tanzania, from 2021 to June 2024, with blood culture confirmed Acinetobacter spp. BSI. Of 421 Gram negative bacteria isolated from the 2901 blood cultures processed, 33 (7.8%) were Acinetobacter spp.. Median age at presentation was 4 days (IQR 2–7), and case fatality was 42.4%. Multidrug resistance (MDR) occurred in 60.6% of isolates, and carbapenem resistance in 44%. Mortality was significantly higher in MDR cases (78.6% vs. 15.4%, p = 0.045) and carbapenem-resistant cases (70.0% vs. 15.4%, p = 0.005). MDR infection was more frequent in neonates admitted with septic conditions (65.0%) or combined septic and respiratory conditions (100%) than with respiratory conditions alone (14.3%). Empirical treatment with more than two antibiotics, or regimens excluding the standard ampicillin and gentamicin combination, was also associated with MDR infection. These findings reveal high mortality and extensive resistance in the isolated Acinetobacter spp. , including the second line agents, underscoring the urgent need for targeted infection prevention, stewardship interventions. Acinetobacter spp. bloodstream infection neonatal sepsis multidrug resistance carbapenem resistance antimicrobial stewardship infection prevention and control Tanzania Figures Figure 1 Figure 2 Introduction Neonatal sepsis remains a significant global health concern, with a substantial burden, particularly in low-and middle-income countries (LMICs) ( 1 , 2 ). Recent estimates indicate a global incidence of 2,824 (95% CI, 1,892 to 4,194) cases per 100,000 live births, with a mortality rate of 17.6% (95% CI, 10.3% to 28.6%)( 2 ). Notably, South Asia and Sub-Saharan Africa bear the highest burden of sepsis rates, 2 to 4 times higher than rates reported in the United Kingdom and the United States( 3 ). Acinetobacter infections in neonates have emerged as a concern due to their association with significant morbidity and mortality, especially in preterm and very low birth weight infants ( 4 , 5 ). The emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) has exacerbated the challenge of effectively treating these infections( 6 ). The increase in prevalence of Acinetobacter infection in neonates has led to an escalation of antibiotic use and more difficult-to-treat infections ( 7 , 8 ). Studies have reported 30-day case fatality rates of Acinetobacter baumannii neonatal sepsis ranging from 36.3% to 39% ( 9 ). Most isolated Acinetobacter spp are reported to be multidrug-resistant (MDR), making them difficult to treat and associated with a poor prognosis in neonatal infections. The primary risk factors for Acinetobacter baumannii infection in neonates include prematurity and low birth weight. Other risk factors include prolonged intravenous antibiotic use, mechanical ventilation, and extended hospital stays( 8 – 10 ). It’s crucial to remember that infections with Acinetobacter spp constitute a significant problem in neonatal care worldwide. Few studies have documented the isolation of Acinetobacter spp in different specimens collected from neonates. Different studies in Tanzania, all conducted in tertiary-level hospitals, have documented the frequency of isolation of Acinetobacter spp, ranging from 6% to 32.2%( 11 – 13 ). Acinetobacter baumannii, Acinetobacter calcoaceticus , and Acinetobacter lwoffii are the three most clinically significant species in the genus, which includes more than fifty species( 14 ). These opportunistic bacteria resist desiccation and disinfectants, they can thrive in various environments, including hospitals( 14 , 15 ). The bacterium’s genome plasticity enables rapid acquisition of antibiotic-resistance genes, leading to multidrug-resistant strains( 16 – 18 ). Due to widespread resistance, treatment options for Acinetobacter infections are becoming increasingly limited; however, combinations of carbapenems, polymyxins, and tigecycline remain effective( 16 ). Despite the frequent isolation, few studies have directly evaluated the clinical outcomes of Acinetobacter species causing neonatal sepsis ( 5 , 11 – 13 ). However, no published study in Tanzania has focused on profiling Acinetobacter species infection in neonates. Therefore, we conducted a study to assess the clinical characteristics of all neonates with laboratory-confirmed Acinetobacter infections isolated from 2021 to June 2024. We followed up retrospectively recruited neonates’ files from the time of their admission until the occurrence of the outcome. Materials and Methods We conducted a retrospective cohort study at Kilimanjaro Christian Medical Centre (KCMC) by reviewing electronic files and extract clinical information of neonates admitted between January 2021 and June 2024. KCMC is a tertiary referral hospital in the Kilimanjaro region of northern Tanzania, which serves approximately 15 million people. The hospital has several departments, including a pediatric and child health department, which features a functional neonatal ward and a neonatal intensive care unit (NICU). The neonatal ward contains a total of 70 bed capacity (baby cots, incubators and radiant warmers) in the general ward and six baby cots in the NICU. The neonatal unit is among the busiest in the hospital, with an average annual admission rate of 1,580. Investigation for bloodstream infection in neonates. The clinical team routinely collects blood samples in the wards, following the standard operating procedures. The microbiology laboratory is equipped with an automated BD BACTEC™ FX blood culture system, where blood samples are incubated immediately after collection. A 1mL to 3mL blood sample is taken from each pediatric patient using BD BACTEC Peds Plus F Culture bottles. Before being deemed negative, the blood culture bottles in the BD BACTEC™ FX system are incubated for five days. The laboratory processes positive blood cultures by performing Gram staining and subculturing onto sheep blood agar, chocolate agar, and MacConkey agar. Identification of Acinetobacter spp is based on colony morphology, Gram stain results, and biochemical tests. A non-lactose fermenting colonies of gram-negative bacilli were identified based on morphology on MacConkey agar, and the isolates were characterized on the species level by performing standard biochemical tests such as Sulphide Indole Motility (SIM test), gas production, citrate test, urease test and oxidase test. Antimicrobial susceptibility testing (AST) was performed and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines for the published versions of that particular year (2021, 2022, 2023 and 2024). The antibiotic discs used for Acinetobacter spp. AST include amikacin, gentamicin, ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam. Study population We assessed clinical information of 33 neonates who were positive with Acinetobacter spp. In their blood culture. Data collection This retrospective cohort study utilized data collected from a thorough review of electronic medical records and laboratory databases of the neonates admitted at KCMC neonatal unit. Only neonates aged between 0 and 28 days with laboratory confirmed bloodstream infections caused by Acinetobacter species were included. Cases with incomplete documentation or without microbiological confirmation were excluded from the analysis. Data were extracted using a well-structured data collection tool to capture information such as sociodemographic factors (age, sex, birth location, delivery method), clinical details (birth weight, gestational age, presenting symptoms, diagnosis), and antibiotic treatment specifics (types of antibiotics used, duration of therapy, and any modifications based on susceptibility testing). Laboratory data included dates of culture collection, identified pathogens, and antimicrobial susceptibility profiles. Outcome measures recorded comprised hospital length of stay, any complications, and discharge status categorized as recovery, referral, or death. Data Management and Analysis Data entry was conducted by trained research assistants and verified by the principal investigator to ensure accuracy. Once cleaned, the dataset was exported to STATA version 17.0 for analysis. Descriptive statistics were used to summarize baseline characteristics, with categorical variables presented as frequencies and percentages, and continuous variables summarized using medians with interquartile ranges. The primary outcome of interest was the case fatality rate among neonates with Acinetobacter bloodstream infections. Bivariate analysis was conducted using Chi-square and variables with p-values <0.2 were included in multivariable logistic regression to identify factors independently associated with mortality. A p-value of <0.05 was considered statistically significant. Ethical Considerations Ethical approval for the study was obtained from the Kilimanjaro Christian Medical University College Research Ethics Review Committee (CRERC). Authorization to access patient records was granted by the KCMC administration. As this was a retrospective review of existing records, informed consent was waived. To maintain confidentiality, all collected data were anonymized using unique identification codes, and no personally identifiable information was recorded. Results Proportion of Acinetobacter bloodstream infection in neonates A total of 2,901 blood samples were collected for culture from the neonatal unit between January 2021 and June 2024, with 1,415 (48.8%) being culture-positive. Among the positive cultures, gram-negative bacteria accounted for 421 out of 1,415 (29.8%). The overall proportion of Acinetobacte r infection among the blood culture positives was 2.3% (33 Out of 1,415). (Fig. 1 ) Characteristics of neonates with Acinetobacter bloodstream infection Among the neonates from whom Acinetobacter species were isolated, most were male (69.7%) and had birth weights within the normal range (60.0%). Most neonates had difficulty breathing (64.5%) and septic conditions (66.7%), with a smaller proportion showing respiratory conditions (23.3%) or both respiratory and septic conditions (10.0%). The primary empirical treatment was ampicillin and gentamicin, either alone (45.2%) or combined with other antibiotics (45.2%). Most neonates (61.29%) received empirical treatment for 0–5 days, and 57.58% had a hospital stay of ≤ 7 days. There was a significant mortality rate of 42.42%. (Table 1 ) Table 1 Socio-demographic and Clinical Characteristics of Neonates admitted in KCMC (N = 33) Variable N % Sex Female 10 30.30 Male 23 69.70 Birthweight * Low Birth Weight 11 36.67 Normal Birth Weight 18 60.00 High Birth Weight 1 3.33 Clinical Presentation at Admission * Difficulty in Breathing 20 64.52 Fever and Other Risk of infection 9 29.03 Congenital and Other anomalies 2 6.45 Diagnosis * Septic conditions 20 66.67 Respiratory conditions 7 23.33 Both septic and respiratory conditions 3 10.00 Empirical Treatment * Ampicillin and Gentamycin 14 45.16 Ampicillin and Gentamycin with other Antibiotics 14 45.16 Other Antibiotics 2 06.45 None 1 03.23 Duration of Empirical Treatment * 0–5 19 61.29 6–11 9 29.03 12–17 3 09.68 Duration from Sample collection to Results (days) 3.36(1.40) Length of Hospital Stay Early Stay (≤ 7 days) 19 57.58 Prolonged Stay (> 7 days) 14 42.42 Outcome Death 14 42.42 Recovered 17 51.52 Not Documented 2 06.06 Antibiotic resistance of Acinetobacter species High resistance rates were observed against third-generation cephalosporins, with Ceftazidime (86.95%) and Ceftriaxone (83.87%) exhibiting the highest resistance among the antibiotics tested. Meropenem, a carbapenem commonly utilized for resistant infections, demonstrated a resistance rate of 44.00%. The least resistance was found for amikacin (37.14%). (Table 2 ) Table 2 Antibiotic Resistance Patterns of Acinetobacter Species in Neonates with Bloodstream Infections from January 2021 to May 2024 Antibiotic Total tested (n) Resistance (%) Amikacin 33 13(37.14) Gentamicin 30 16(53.33) Ceftriaxone 31 26(83.87) Ceftazidime 23 20(86.95) Cefepime 13 10(76.92) Ciprofloxacin 23 12(52.17) Meropenem 25 11(44.00) Piperacin-Tazobactam 21 14(66.67) Trimethoprim/sulfamethoxazole 22 14(63.64) Phenotypic Multi-Drug Resistance (MDR) Patterns of Acinetobacter species The proportion of multidrug-resistant Acinetobacter species was 60.6% (20 out of 33). This bar chart (Fig. 2 ) illustrates the distribution of multidrug resistance (MDR) patterns in Acinetobacter spp across various combinations of antibiotic classes. The most common resistance pattern was observed against six antibiotic classes (cephalosporins/ aminoglycosides/ fluoroquinolones/ Penicillins/ carbapenems/ sulfonamides), identified in 6(18.2%) of isolates. The combinations involving cephalosporins and aminoglycosides were prevalent 17 (85.0%), often paired with other classes, such as fluoroquinolones, penicillin, carbapenems, and sulfonamides. This chart highlights the diverse resistance profiles of Acinetobacter spp. Isolates and the frequent involvement of multiple antibiotic classes, underscoring the complexity of treating these infections. The widespread resistance to multiple drug classes emphasizes the need for cautious and targeted antibiotic use in clinical settings. (Fig. 2 ) Antibiotic Classes Factors associated with Multi-Drug Resistance (MDR) and Carbapenem Resistance Acinetobacter species infection in neonates admitted at KCMC neonatal unit. MDR Acinetobacter spp . was notably associated with higher mortality rates, with 78.57% of deaths occurring among MDR cases (p = 0.045). Similarly, isolation of carbapenem resistance Acinetobacter spp. was strongly associated with death (70.0% vs. 15.38%; p = 0.005). Neonates who had diagnosis related to septic condition alone or with respiratory condition (septic conditions (65.0%) and combined septic and respiratory conditions (100%) had higher chances of MDR Acinetobacter infection compared to those who were admitted with respiratory condition alone (14.29%). (Table 3 ) Neonates who were treated empirically with more than 2 antibiotic (ampicillin + gentamicin with an additional antibiotic (78.57%)) or other antibiotics excluding ampicillin + gentamicin (100%) were significantly associated with isolation of MRD Acinetobacter spp infection. Other factors which were studied including female neonate (70.0%), being born with low birthweight (81.82%), neonates empirically treatment for duration between 12 to 17 days and those who stayed in the neonatal unit for more than 7 days (78.57%), were found to have increased risk of MDR Acinetobacter spp. isolation, however this observation was not statistically significant. (Table 3 ) Table 3 Factors associated with Multi-Drug Resistance (MDR) and Carbapenem Resistance Acinetobacter species infection in neonates admitted at KCMC neonatal unit. Variable MDR strains N = 33 Carb-Resistant N = 25 n (%) p-value n (%) P-value Sex 0.701 0.241 Male 13 (56.5) 5 (33.3) Female 07 (70.0) 6 (60.0) Outcome 0.045 0.005 Recovered 07 (41.2) 2(15.4) Death 11 (78.6) 7(70.0) Not documented 02 (100.0) 2(100.0) Birthweight * 0.057 0.662 High Birth Weight 0 (0.0) 0(0.00) Low Birth Weight 9 (81.8) 4(44.4) Normal Birth Weight 8 (44.4) 4(30.8) Clinical Presentation at Admission * 0.709 0.133 Congenital and other anomalies 02 (100.0) 02(100.0) Difficult in breathing 11 (55.0) 06(42.9) Fever and other Risk of infection 05 (55.6) 01(14.3) Diagnosis * 0.021 0.311 Septic + Respiratory Conditions 03 (100.0) 02(100.0) Respiratory Conditions 01 (14.3) 01 (25.0) Septic Conditions 13 (65.0) 06 (37.5) Empirical Treatment* 0.022 0.092 Ampicloxacillin and gentamycin 05 (35.7) 02 (20.0) Ampicloxacillin and gentamycin and other antibiotic 11 (78.6) 05 (45.5) No antibiotics given 0 (0.0) 0 (0.00) Other antibiotics but not Ampicloxacillin and gentamycin 02 (100.0) 02(100.0) Duration of Empirical Treatment * 0.269 0.176 0–5 days 11 (57.9) 04(28.6) 6–11 days 04 (44.4) 03(42.7) 12–17 days 03 (100.0) 0(100.0) Length of Hospital Stay 0.070 0.165 Early Stay (≤ 7 days) 09 (47.6) 04(30.8) Prolonged Stay (> 7 days) 11 (78.7) 07(58.3) Discussion This study analyzed the morbidity and mortality associated with Acinetobacter spp bloodstream infections in the neonatal unit of a tertiary hospital in Tanzania over a three-year surveillance period. From 2021 to 2025, a total of 2,901 blood cultures were collected. A positive blood culture was obtained from 1,415 samples, of which 2.5% were positive for Acinetobacter spp similar results were observed in a study done in India, showing 9.18% of culture-positive samples being Acinetobacter( 4 ). Acinetobacter spp . has been shown to cause severe disease, particularly in tropical countries( 19 ). In this retrospective cross-sectional study, the mortality rate associated with Acinetobacter spp . Bacteremia was 42.4%. Similar findings were reported in other studies, with one showing a mortality rate of 30% and another reporting an even higher rate of 59%( 20 , 21 ). Conversely, a separate study demonstrated an improvement in mortality, decreasing from earlier rates of 50%–60% to 30%. This improvement was attributed not to advances in antimicrobial therapy, but rather to enhancements in the care of critically ill patients( 22 , 23 ). These findings suggest that improving outcomes in Acinetobacter spp. Bacteremia requires a multifaceted approach, combining better antimicrobial stewardship with continued progress in critical care. In recent years, a rising tide of multidrug resistance (MDR) has been observed in Acinetobacter spp. Several studies have identified risk factors associated with Acinetobacter spp. Infections, including low birth weight, prematurity, incubation, and mechanical ventilation( 8 ). In this study, MDR Acinetobacter was found more frequently in neonates with low birth weight (81.8%) compared to those with normal birth weight (44.4%). Although this difference was not statistically significant, similar findings were observed in a study done in Indonesia( 24 ). Other risk factors included congenital anomalies, with 100% of such cases testing positive for MDR Acinetobacter spp . The World Health Organization has identified Acinetobacter spp. as one of the most critical multidrug-resistant organisms in need of new antibiotics ( 25 ). In this study, the species demonstrated high resistance to multiple commonly used antibiotics, particularly third-generation cephalosporins, with resistance rates of 86.95% and 83.87% to ceftazidime and ceftriaxone, respectively. Meropenem resistance was also substantial at 44%, in line with findings from a systematic review and meta-analysis conducted in Ethiopia, which reported a resistance rate of 43.58% ( 26 ). These resistance patterns are largely attributed to bacterial mechanisms such as altered penicillin-binding proteins, the production of Metallo-beta-lactamases, and porin loss( 27 , 28 ). The overuse of ceftriaxone, especially as monotherapy, and the widespread application of fixed-dose combinations, such as ceftriaxone-sulbactam, have likely contributed to the compounding resistance, highlighting gaps in antimicrobial stewardship practices( 29 , 30 ). Resistance was also notably high for piperacillin-tazobactam (66.67%), echoing trends observed in Uganda, where a 70% resistance rate has been reported( 31 ), and consistent with recent findings in Tanzania, which showed increased resistance, particularly among extended-spectrum beta-lactamase(ESBL) producing Gram-negative bacteria( 32 , 33 ). Ciprofloxacin resistance reached 52.17%, likely due to its frequent use for both treatment and prophylaxis in the region( 34 ). Among aminoglycosides, gentamicin had a resistance rate of 66.67%, whereas amikacin showed the lowest resistance (37.14%), suggesting its retained activity and lower usage rate. The superior in vitro efficacy of amikacin compared to other aminoglycosides, such as gentamicin and tobramycin, reinforces the importance of selective prescribing to slow the development of resistance and preserve remaining treatment options( 35 ). In this study, the most common resistance pattern involved six antibiotic classes (CEP/AMINO/FQN/PEN/CAR/SUL), observed in six isolates, indicating broad resistance across multiple drug classes. Combinations involving cephalosporins (CEP) and aminoglycosides (AMINO) were particularly prevalent and were often paired with fluoroquinolones (FQN), penicillin (PEN), carbapenems (CAR), and sulfonamides (SUL). Less frequent patterns included combinations involving three or four drug classes, such as CEP/AMINO/PEN and CEP/FQN/PEN, indicating varying levels of MDR among isolates. According to the WHO AWaRe classification, amikacin and gentamicin fall under the Access group; ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam are categorized under the Watch group ( 36 ). This study highlights that Acinetobacter spp. has developed resistance to both Access and Watch group antibiotics, underscoring the potential future need to rely on Reserve group medications, such as colistin Given the significant challenge posed by multidrug-resistant (MDR) Acinetobacter spp. and the emergence and spread of resistance mechanisms to nearly all existing antimicrobial agents, it is imperative to explore solutions beyond the traditional antibiotic paradigm ( 37 ). A. baumannii is part of the ESKAPE group of pathogens, which are major contributors to antibiotic-resistant infections( 38 ). The prolonged use of antibiotics has nearly brought us back to the pre-antibiotic era due to the accelerating antimicrobial and multidrug resistance, coupled with the rise of infections caused by ESKAPE pathogens( 39 ). The consequences of AMR extend beyond individual patient outcomes, affecting public health on a global scale due to increased healthcare costs and complicated infection control measures ( 40 ).Targeted infection control interventions focused on Acinetobacter species must be developed and rigorously evaluated. Furthermore, implementing a coordinated multinational antimicrobial stewardship strategy is essential for effectively addressing this escalating threat. Conclusion This study demonstrates the significant prevalence and clinically complicated nature of bloodstream infections caused by Acinetobacter spp. in newborns who were at KCMC, Tanzania. Elevated mortality was linked to high rates of multidrug resistance, including carbapenem resistance, especially in low birth weight and sick newborns. These results underscore the crucial need for robust antimicrobial stewardship programs, enhanced infection control measures, and revision of empirical therapies in newborn care facilities. Declarations Acknowledgement The authors extend their sincere gratitude to the management of Kilimanjaro Christian Medical Centre for permitting us to access its hospital’s medical records and providing an exemplary environment during data collection. We thank all clinicians and laboratory personnel for their various forms of support throughout this phase. Authors’ contributions A.G.M., A.S., E.M.N., and M.M. contributed to study conception and design. F.E.L., E.K. and A.N. did the clinical data collection. M.K., J.M., A.M. and PM supported laboratory collection, analysis and data validation. F.S. and N.P. did the statistical analysis of all the study data and report writing. A.G.M., M.K., C.J. and M.M. were involved in drafting this manuscript. B.T.M., A.S., A.G.M., and M.M. interpreted the data and critically reviewed the manuscript. All authors read and approved the final version of the manuscript. Conflict of interest The authors declare that they have no conflicts of interest. Funding The author(s) received no specific funding for this work. Data availability All relevant data generated is included in this manuscript. However, the corresponding author can share any information upon reasonable request. Ethical approval Permission to write the report was granted by the Kilimanjaro Christian Medical University College Research Ethics Review Committee (CRERC). References Migamba SM, Kisaakye E, Komakech A, Nakanwagi M, Nakamya P, Mutumba R, et al. Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020. BMC Pregnancy Childbirth. 2023;23(1):1–9. 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Available from: https://www.sciencedirect.com/science/article/pii/S2590088922000130 Mwandigha AM, Kamori D, Kibwana UO, Masoud S, Manyahi J, Majigo M. Fecal carriage and factors associated with Enterobacteriaceae among pregnant women at the tertiary referral hospital , Tanzania. 2020;2. Tanzania M of H in. Standard Treatment Guidelines and Essential Medicines List for Tanzania. Stand Treat Guidel Essent Med List [Internet]. 2021;14.10. Available from: https://knowledgehub.health.gov.za/system/files/elibdownloads/2024-07/Paediatric_STGs_and_EML_2023_Edition_Updated_July_2024%5B1%5D.pdf Schmitz FJ, Verhoef J, Fluit AC. Prevalence of aminoglycoside resistance in 20 European university hospitals participating in the European SENTRY Antimicrobial Surveillance Programme. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 1999 Jun;18(6):414–21. Reference 21 WHO AWaRe. Courvalin P. Antimicrobial drug resistance: “Prediction is very difficult, especially about the future.” Emerg Infect Dis. 2005;11(10):1503–6. Mukhopadhyay H, Bairagi A, Mukherjee A, Prasad AK, Roy AD, Nayak A. Multidrug resistant Acinetobacter baumannii: A study on its pathogenesis and therapeutics. Curr Res Microb Sci [Internet]. 2025;8(December 2024):100331. Available from: https://doi.org/10.1016/j.crmicr.2024.100331 Kulshrestha M, Tiwari M, Tiwari V. Bacteriophage therapy against ESKAPE bacterial pathogens: Current status, strategies, challenges, and future scope. Microb Pathog [Internet]. 2024;186:106467. Available from: https://www.sciencedirect.com/science/article/pii/S0882401023005004 Ravi K, Singh B. ESKAPE: Navigating the Global Battlefield for Antimicrobial Resistance and Defense in Hospitals. Bacteria. 2024;3(2):76–98. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8370266","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587143522,"identity":"557301d2-b7d7-485b-8656-5a60e9676e33","order_by":0,"name":"ANTHON GEORGE MWINGWA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYHACNgjFDCZtgJix8QB+HcwoWtJAWhqI1AIBh8EkXi38s/uPPfi443C0wXHew695as7brW0/DLSlxiYalxaJO4fZDWeeOZy74TBfmjXPsdvJ284kArUcS8ttwKXnRjKbNG/b4dxth3nMjHPYbiebHQBqYWw4jFOLPKqWf+eSzc4/xK/FAEmL8ePctgN2ZjcI2GJ4I9lMcmZbeu5+oC3Mf/uSE8xuAG1JwOMXuRuJzyQ+tlnnzuw/Y/xxxjc7e7Pz6Q8ffKixwe19CGgGEWwSQCIRrDIBv3IQqAMRzB+AhD1hxaNgFIyCUTDSAABsZGakVNVtcgAAAABJRU5ErkJggg==","orcid":"","institution":"KCMC University","correspondingAuthor":true,"prefix":"","firstName":"ANTHON","middleName":"GEORGE","lastName":"MWINGWA","suffix":""},{"id":587143525,"identity":"b9008fa4-0370-4524-82e8-de2613ba394a","order_by":1,"name":"Michael Bokobola","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Bokobola","suffix":""},{"id":587143528,"identity":"891ad7a0-9119-404b-ba4f-0d8efe976f28","order_by":2,"name":"Careen J. Josiah","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Careen","middleName":"J.","lastName":"Josiah","suffix":""},{"id":587143530,"identity":"aaa3362d-5571-4e0f-86e1-baa07de9b282","order_by":3,"name":"Elieshiupendo M Niccodem","email":"","orcid":"","institution":"KCMC University","correspondingAuthor":false,"prefix":"","firstName":"Elieshiupendo","middleName":"M","lastName":"Niccodem","suffix":""},{"id":587143532,"identity":"a448e856-1b75-463f-a68c-7682dad7d6ed","order_by":4,"name":"Joshua Mafipa","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Mafipa","suffix":""},{"id":587143533,"identity":"e65a827a-8fa7-4d49-ab45-77b675e2d341","order_by":5,"name":"Flavya E Lazaro","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Flavya","middleName":"E","lastName":"Lazaro","suffix":""},{"id":587143536,"identity":"dac7a9bf-4672-4bf0-ad9d-c01b0d4f9ab3","order_by":6,"name":"Anthony Ngowi","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Ngowi","suffix":""},{"id":587143539,"identity":"d46ea743-c796-4884-8560-664d18521fdb","order_by":7,"name":"Frijenia Sumbai","email":"","orcid":"","institution":"Kilimanjaro Clinical Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Frijenia","middleName":"","lastName":"Sumbai","suffix":""},{"id":587143543,"identity":"d32ff28f-309c-4b72-ae26-cbc049e713a6","order_by":8,"name":"Patrick Minde","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"Minde","suffix":""},{"id":587143546,"identity":"719e6258-4a83-49b1-aea7-8f42fae1bc70","order_by":9,"name":"Adam Mwakyoma","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Mwakyoma","suffix":""},{"id":587143553,"identity":"917a5f58-bf92-4569-afff-5892973edf1a","order_by":10,"name":"Elise Kimambo","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Elise","middleName":"","lastName":"Kimambo","suffix":""},{"id":587143556,"identity":"24f997ac-e000-4f61-a68b-e04889d94e9a","order_by":11,"name":"Nyemo Peter","email":"","orcid":"","institution":"Kilimanjaro Christian Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Nyemo","middleName":"","lastName":"Peter","suffix":""},{"id":587143558,"identity":"cc87457f-f88a-4d6f-aaa8-6d946bc1d9b4","order_by":12,"name":"Aisa Shayo","email":"","orcid":"","institution":"KCMC University","correspondingAuthor":false,"prefix":"","firstName":"Aisa","middleName":"","lastName":"Shayo","suffix":""},{"id":587143559,"identity":"5c5e5fa9-ad49-48f3-ae6d-bc1678412541","order_by":13,"name":"Blandina T Mmbaga","email":"","orcid":"","institution":"Kilimanjaro Clinical Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Blandina","middleName":"T","lastName":"Mmbaga","suffix":""},{"id":587143560,"identity":"8679b872-48ac-4ecf-8448-d48b14b655c3","order_by":14,"name":"Majigo Mtebe","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Majigo","middleName":"","lastName":"Mtebe","suffix":""}],"badges":[],"createdAt":"2025-12-15 22:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8370266/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8370266/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102214922,"identity":"d1369698-f2f6-457f-b85c-00ad2e6f9971","added_by":"auto","created_at":"2026-02-09 12:47:46","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":86843,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of Acinetobacter bloodstream infection among neonates\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8370266/v1/62166ef2ab36e89bf6e269e3.jpg"},{"id":102214921,"identity":"e7c9f50c-c144-40eb-a23f-5a4d597c8d70","added_by":"auto","created_at":"2026-02-09 12:47:45","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":78940,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Multi-Drug Resistance (MDR) Patterns in Acinetobacter spp. Isolates by Antibiotic Classes\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8370266/v1/565317fd954399108fbd5fd4.jpg"},{"id":102297618,"identity":"9a1c6e3c-d337-4552-b796-eaa697cbf475","added_by":"auto","created_at":"2026-02-10 10:28:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1295557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8370266/v1/f943affd-50bb-4a93-b351-8a0d25ce46e6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal sepsis remains a significant global health concern, with a substantial burden, particularly in low-and middle-income countries (LMICs) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Recent estimates indicate a global incidence of 2,824 (95% CI, 1,892 to 4,194) cases per 100,000 live births, with a mortality rate of 17.6% (95% CI, 10.3% to 28.6%)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Notably, South Asia and Sub-Saharan Africa bear the highest burden of sepsis rates, 2 to 4 times higher than rates reported in the United Kingdom and the United States(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcinetobacter\u003c/em\u003e infections in neonates have emerged as a concern due to their association with significant morbidity and mortality, especially in preterm and very low birth weight infants (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The emergence of carbapenem-resistant \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (CRAB) has exacerbated the challenge of effectively treating these infections(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The increase in prevalence of \u003cem\u003eAcinetobacter\u003c/em\u003e infection in neonates has led to an escalation of antibiotic use and more difficult-to-treat infections (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Studies have reported 30-day case fatality rates of \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e neonatal sepsis ranging from 36.3% to 39% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Most isolated \u003cem\u003eAcinetobacter spp\u003c/em\u003e are reported to be multidrug-resistant (MDR), making them difficult to treat and associated with a poor prognosis in neonatal infections.\u003c/p\u003e \u003cp\u003eThe primary risk factors for \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e infection in neonates include prematurity and low birth weight. Other risk factors include prolonged intravenous antibiotic use, mechanical ventilation, and extended hospital stays(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It\u0026rsquo;s crucial to remember that infections with \u003cem\u003eAcinetobacter spp\u003c/em\u003e constitute a significant problem in neonatal care worldwide. Few studies have documented the isolation of \u003cem\u003eAcinetobacter spp\u003c/em\u003e in different specimens collected from neonates. Different studies in Tanzania, all conducted in tertiary-level hospitals, have documented the frequency of isolation of \u003cem\u003eAcinetobacter\u003c/em\u003e spp, ranging from 6% to 32.2%(\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcinetobacter baumannii, Acinetobacter calcoaceticus\u003c/em\u003e, and \u003cem\u003eAcinetobacter lwoffii\u003c/em\u003e are the three most clinically significant species in the genus, which includes more than fifty species(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These opportunistic bacteria resist desiccation and disinfectants, they can thrive in various environments, including hospitals(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The bacterium\u0026rsquo;s genome plasticity enables rapid acquisition of antibiotic-resistance genes, leading to multidrug-resistant strains(\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Due to widespread resistance, treatment options for \u003cem\u003eAcinetobacter\u003c/em\u003e infections are becoming increasingly limited; however, combinations of carbapenems, polymyxins, and tigecycline remain effective(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the frequent isolation, few studies have directly evaluated the clinical outcomes of \u003cem\u003eAcinetobacter\u003c/em\u003e species causing neonatal sepsis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, no published study in Tanzania has focused on profiling \u003cem\u003eAcinetobacter\u003c/em\u003e species infection in neonates. Therefore, we conducted a study to assess the clinical characteristics of all neonates with laboratory-confirmed \u003cem\u003eAcinetobacter\u003c/em\u003e infections isolated from 2021 to June 2024. We followed up retrospectively recruited neonates\u0026rsquo; files from the time of their admission until the occurrence of the outcome.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe conducted a retrospective cohort study at Kilimanjaro Christian Medical Centre (KCMC) by reviewing electronic files and extract clinical information of neonates admitted between January 2021 and June 2024. KCMC is a tertiary referral hospital in the Kilimanjaro region of northern Tanzania, which serves approximately 15 million people. The hospital has several departments, including a pediatric and child health department, which features a functional neonatal ward and a neonatal intensive care unit (NICU). The neonatal ward contains a total of 70 bed capacity (baby cots, incubators and radiant warmers) in the general ward and six baby cots in the NICU. The neonatal unit is among the busiest in the hospital, with an average annual admission rate of 1,580.\u003c/p\u003e\n\u003cp\u003eInvestigation for bloodstream infection in neonates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe clinical team routinely collects blood samples in the wards, following the standard operating procedures. The microbiology laboratory is equipped with an automated BD BACTEC\u0026trade; FX blood culture system, where blood samples are incubated immediately after collection. A 1mL to 3mL blood sample is taken from each pediatric patient using BD BACTEC Peds Plus F Culture bottles. Before being deemed negative, the blood culture bottles in the BD BACTEC\u0026trade; FX system are incubated for five days. The laboratory processes positive blood cultures by performing Gram staining and subculturing onto sheep blood agar, chocolate agar, and MacConkey agar. Identification of \u003cem\u003eAcinetobacter spp\u0026nbsp;\u003c/em\u003eis based on colony morphology, Gram stain results, and biochemical tests. A non-lactose fermenting colonies of gram-negative bacilli were identified based on morphology on MacConkey agar, and the isolates were characterized on the species level by performing standard biochemical tests such as Sulphide Indole Motility (SIM test), gas production, citrate test, urease test and oxidase test. Antimicrobial susceptibility testing (AST) was performed and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines for the published versions of that particular year (2021, 2022, 2023 and 2024). The antibiotic discs used for \u003cem\u003eAcinetobacter spp.\u0026nbsp;\u003c/em\u003eAST include amikacin, gentamicin, ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy population\u003c/p\u003e\n\u003cp\u003eWe assessed clinical information of 33 neonates who were positive with\u003cem\u003e\u0026nbsp;Acinetobacter\u003c/em\u003e spp. In their blood culture. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData collection\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study utilized data collected from a thorough review of electronic medical records and laboratory databases of the neonates admitted at KCMC neonatal unit. Only neonates aged between 0 and 28 days with laboratory confirmed bloodstream infections caused by Acinetobacter species were included. Cases with incomplete documentation or without microbiological confirmation were excluded from the analysis.\u003c/p\u003e\n\u003cp\u003eData were extracted using a well-structured data collection tool to capture information such as sociodemographic factors (age, sex, birth location, delivery method), clinical details (birth weight, gestational age, presenting symptoms, diagnosis), and antibiotic treatment specifics (types of antibiotics used, duration of therapy, and any modifications based on susceptibility testing). Laboratory data included dates of culture collection, identified pathogens, and antimicrobial susceptibility profiles. Outcome measures recorded comprised hospital length of stay, any complications, and discharge status categorized as recovery, referral, or death.\u003c/p\u003e\n\u003cp\u003eData Management and Analysis\u003c/p\u003e\n\u003cp\u003eData entry was conducted by trained research assistants and verified by the principal investigator to ensure accuracy. Once cleaned, the dataset was exported to STATA version 17.0 for analysis. Descriptive statistics were used to summarize baseline characteristics, with categorical variables presented as frequencies and percentages, and continuous variables summarized using medians with interquartile ranges. The primary outcome of interest was the case fatality rate among neonates with Acinetobacter bloodstream infections. Bivariate analysis was conducted using Chi-square and variables with p-values \u0026lt;0.2 were included in multivariable logistic regression to identify factors independently associated with mortality. A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was obtained from the Kilimanjaro Christian Medical University College Research Ethics Review Committee (CRERC). Authorization to access patient records was granted by the KCMC administration. As this was a retrospective review of existing records, informed consent was waived. To maintain confidentiality, all collected data were anonymized using unique identification codes, and no personally identifiable information was recorded.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eProportion of Acinetobacter bloodstream infection in neonates\u003c/h2\u003e \u003cp\u003eA total of 2,901 blood samples were collected for culture from the neonatal unit between January 2021 and June 2024, with 1,415 (48.8%) being culture-positive. Among the positive cultures, gram-negative bacteria accounted for 421 out of 1,415 (29.8%). The overall proportion of \u003cem\u003eAcinetobacte\u003c/em\u003er infection among the blood culture positives was 2.3% (33 Out of 1,415). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCharacteristics of neonates with Acinetobacter bloodstream infection\u003c/h3\u003e\n\u003cp\u003eAmong the neonates from whom \u003cem\u003eAcinetobacter\u003c/em\u003e species were isolated, most were male (69.7%) and had birth weights within the normal range (60.0%). Most neonates had difficulty breathing (64.5%) and septic conditions (66.7%), with a smaller proportion showing respiratory conditions (23.3%) or both respiratory and septic conditions (10.0%). The primary empirical treatment was ampicillin and gentamicin, either alone (45.2%) or combined with other antibiotics (45.2%). Most neonates (61.29%) received empirical treatment for 0\u0026ndash;5 days, and 57.58% had a hospital stay of \u0026le;\u0026thinsp;7 days. There was a significant mortality rate of 42.42%. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic and Clinical Characteristics of Neonates admitted in KCMC (N\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirthweight *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Presentation at Admission *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifficulty in Breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever and Other Risk of infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongenital and Other anomalies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth septic and respiratory conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmpirical Treatment *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpicillin and Gentamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmpicillin and Gentamycin with other Antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Antibiotics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e06.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e03.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Empirical Treatment *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e09.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration from Sample collection to Results (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.36(1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Hospital Stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEarly Stay (\u0026le;\u0026thinsp;7 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProlonged Stay (\u0026gt;\u0026thinsp;7 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Documented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e06.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eAntibiotic resistance of\u003c/b\u003e \u003cb\u003eAcinetobacter\u003c/b\u003e \u003cb\u003especies\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHigh resistance rates were observed against third-generation cephalosporins, with Ceftazidime (86.95%) and Ceftriaxone (83.87%) exhibiting the highest resistance among the antibiotics tested. Meropenem, a carbapenem commonly utilized for resistant infections, demonstrated a resistance rate of 44.00%. The least resistance was found for amikacin (37.14%). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAntibiotic Resistance Patterns of Acinetobacter Species in Neonates with Bloodstream Infections from January 2021 to May 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal tested (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResistance (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmikacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(37.14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentamicin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(53.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftriaxone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(83.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCeftazidime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(86.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCefepime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(76.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiprofloxacin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(52.17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeropenem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(44.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePiperacin-Tazobactam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(66.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrimethoprim/sulfamethoxazole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(63.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePhenotypic Multi-Drug Resistance (MDR) Patterns of\u003c/b\u003e \u003cb\u003eAcinetobacter\u003c/b\u003e \u003cb\u003especies\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe proportion of multidrug-resistant \u003cem\u003eAcinetobacter\u003c/em\u003e species was 60.6% (20 out of 33). This bar chart (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) illustrates the distribution of multidrug resistance (MDR) patterns in \u003cem\u003eAcinetobacter\u003c/em\u003e spp across various combinations of antibiotic classes. The most common resistance pattern was observed against six antibiotic classes (cephalosporins/ aminoglycosides/ fluoroquinolones/ Penicillins/ carbapenems/ sulfonamides), identified in 6(18.2%) of isolates. The combinations involving cephalosporins and aminoglycosides were prevalent 17 (85.0%), often paired with other classes, such as fluoroquinolones, penicillin, carbapenems, and sulfonamides. This chart highlights the diverse resistance profiles of Acinetobacter spp. Isolates and the frequent involvement of multiple antibiotic classes, underscoring the complexity of treating these infections. The widespread resistance to multiple drug classes emphasizes the need for cautious and targeted antibiotic use in clinical settings. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAntibiotic Classes\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with Multi-Drug Resistance (MDR) and Carbapenem Resistance Acinetobacter species infection in neonates admitted at KCMC neonatal unit.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMDR \u003cem\u003eAcinetobacter spp\u003c/em\u003e. was notably associated with higher mortality rates, with 78.57% of deaths occurring among MDR cases (p\u0026thinsp;=\u0026thinsp;0.045). Similarly, isolation of carbapenem resistance \u003cem\u003eAcinetobacter spp.\u003c/em\u003e was strongly associated with death (70.0% vs. 15.38%; p\u0026thinsp;=\u0026thinsp;0.005). Neonates who had diagnosis related to septic condition alone or with respiratory condition (septic conditions (65.0%) and combined septic and respiratory conditions (100%) had higher chances of MDR Acinetobacter infection compared to those who were admitted with respiratory condition alone (14.29%). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNeonates who were treated empirically with more than 2 antibiotic (ampicillin\u0026thinsp;+\u0026thinsp;gentamicin with an additional antibiotic (78.57%)) or other antibiotics excluding ampicillin\u0026thinsp;+\u0026thinsp;gentamicin (100%) were significantly associated with isolation of MRD \u003cem\u003eAcinetobacter spp\u003c/em\u003e infection. Other factors which were studied including female neonate (70.0%), being born with low birthweight (81.82%), neonates empirically treatment for duration between 12 to 17 days and those who stayed in the neonatal unit for more than 7 days (78.57%), were found to have increased risk of MDR \u003cem\u003eAcinetobacter spp.\u003c/em\u003e isolation, however this observation was not statistically significant. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with Multi-Drug Resistance (MDR) and Carbapenem Resistance Acinetobacter species infection in neonates admitted at KCMC neonatal unit.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMDR strains\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;33\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eCarb-Resistant\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;25\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e07 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOutcome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRecovered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e07 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNot documented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e02 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirthweight *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.057\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.662\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHigh Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLow Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNormal Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Presentation at Admission *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.709\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.133\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCongenital and other anomalies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e02 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e02(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDifficult in breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e06(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFever and other Risk of infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e05 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e01(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnosis *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.311\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSeptic\u0026thinsp;+\u0026thinsp;Respiratory Conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e03 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e02(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRespiratory Conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e01 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e01 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSeptic Conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e06 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmpirical Treatment*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.092\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAmpicloxacillin and gentamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e05 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e02 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAmpicloxacillin and gentamycin and other antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e05 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo antibiotics given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOther antibiotics but not Ampicloxacillin and gentamycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e02 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e02(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of Empirical Treatment *\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.269\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.176\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e04(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e04 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e03(42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e12\u0026ndash;17 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e03 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Hospital Stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.070\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.165\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEarly Stay (\u0026le;\u0026thinsp;7 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e09 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e04(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProlonged Stay (\u0026gt;\u0026thinsp;7 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e07(58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study analyzed the morbidity and mortality associated with \u003cem\u003eAcinetobacter\u003c/em\u003e spp bloodstream infections in the neonatal unit of a tertiary hospital in Tanzania over a three-year surveillance period. From 2021 to 2025, a total of 2,901 blood cultures were collected. A positive blood culture was obtained from 1,415 samples, of which 2.5% were positive for \u003cem\u003eAcinetobacter spp\u003c/em\u003e similar results were observed in a study done in India, showing 9.18% of culture-positive samples being Acinetobacter(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcinetobacter spp\u003c/em\u003e. has been shown to cause severe disease, particularly in tropical countries(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In this retrospective cross-sectional study, the mortality rate associated with \u003cem\u003eAcinetobacter spp\u003c/em\u003e. Bacteremia was 42.4%. Similar findings were reported in other studies, with one showing a mortality rate of 30% and another reporting an even higher rate of 59%(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Conversely, a separate study demonstrated an improvement in mortality, decreasing from earlier rates of 50%\u0026ndash;60% to 30%. This improvement was attributed not to advances in antimicrobial therapy, but rather to enhancements in the care of critically ill patients(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These findings suggest that improving outcomes in \u003cem\u003eAcinetobacter spp.\u003c/em\u003e Bacteremia requires a multifaceted approach, combining better antimicrobial stewardship with continued progress in critical care.\u003c/p\u003e \u003cp\u003eIn recent years, a rising tide of multidrug resistance (MDR) has been observed in \u003cem\u003eAcinetobacter\u003c/em\u003e spp. Several studies have identified risk factors associated with \u003cem\u003eAcinetobacter\u003c/em\u003e spp. Infections, including low birth weight, prematurity, incubation, and mechanical ventilation(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In this study, MDR \u003cem\u003eAcinetobacter\u003c/em\u003e was found more frequently in neonates with low birth weight (81.8%) compared to those with normal birth weight (44.4%). Although this difference was not statistically significant, similar findings were observed in a study done in Indonesia(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Other risk factors included congenital anomalies, with 100% of such cases testing positive for MDR \u003cem\u003eAcinetobacter spp\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThe World Health Organization has identified Acinetobacter spp. as one of the most critical multidrug-resistant organisms in need of new antibiotics (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In this study, the species demonstrated high resistance to multiple commonly used antibiotics, particularly third-generation cephalosporins, with resistance rates of 86.95% and 83.87% to ceftazidime and ceftriaxone, respectively. Meropenem resistance was also substantial at 44%, in line with findings from a systematic review and meta-analysis conducted in Ethiopia, which reported a resistance rate of 43.58% (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). These resistance patterns are largely attributed to bacterial mechanisms such as altered penicillin-binding proteins, the production of Metallo-beta-lactamases, and porin loss(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The overuse of ceftriaxone, especially as monotherapy, and the widespread application of fixed-dose combinations, such as ceftriaxone-sulbactam, have likely contributed to the compounding resistance, highlighting gaps in antimicrobial stewardship practices(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResistance was also notably high for piperacillin-tazobactam (66.67%), echoing trends observed in Uganda, where a 70% resistance rate has been reported(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and consistent with recent findings in Tanzania, which showed increased resistance, particularly among extended-spectrum beta-lactamase(ESBL) producing Gram-negative bacteria(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Ciprofloxacin resistance reached 52.17%, likely due to its frequent use for both treatment and prophylaxis in the region(\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Among aminoglycosides, gentamicin had a resistance rate of 66.67%, whereas amikacin showed the lowest resistance (37.14%), suggesting its retained activity and lower usage rate. The superior in vitro efficacy of amikacin compared to other aminoglycosides, such as gentamicin and tobramycin, reinforces the importance of selective prescribing to slow the development of resistance and preserve remaining treatment options(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, the most common resistance pattern involved six antibiotic classes (CEP/AMINO/FQN/PEN/CAR/SUL), observed in six isolates, indicating broad resistance across multiple drug classes. Combinations involving cephalosporins (CEP) and aminoglycosides (AMINO) were particularly prevalent and were often paired with fluoroquinolones (FQN), penicillin (PEN), carbapenems (CAR), and sulfonamides (SUL). Less frequent patterns included combinations involving three or four drug classes, such as CEP/AMINO/PEN and CEP/FQN/PEN, indicating varying levels of MDR among isolates. According to the WHO AWaRe classification, amikacin and gentamicin fall under the Access group; ceftriaxone, ceftazidime, cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam are categorized under the Watch group (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). This study highlights that \u003cem\u003eAcinetobacter\u003c/em\u003e spp. has developed resistance to both Access and Watch group antibiotics, underscoring the potential future need to rely on Reserve group medications, such as colistin\u003c/p\u003e \u003cp\u003eGiven the significant challenge posed by multidrug-resistant (MDR) \u003cem\u003eAcinetobacter spp.\u003c/em\u003e and the emergence and spread of resistance mechanisms to nearly all existing antimicrobial agents, it is imperative to explore solutions beyond the traditional antibiotic paradigm (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). \u003cem\u003eA. baumannii\u003c/em\u003e is part of the ESKAPE group of pathogens, which are major contributors to antibiotic-resistant infections(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The prolonged use of antibiotics has nearly brought us back to the pre-antibiotic era due to the accelerating antimicrobial and multidrug resistance, coupled with the rise of infections caused by ESKAPE pathogens(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The consequences of AMR extend beyond individual patient outcomes, affecting public health on a global scale due to increased healthcare costs and complicated infection control measures (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).Targeted infection control interventions focused on \u003cem\u003eAcinetobacter\u003c/em\u003e species must be developed and rigorously evaluated. Furthermore, implementing a coordinated multinational antimicrobial stewardship strategy is essential for effectively addressing this escalating threat.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates the significant prevalence and clinically complicated nature of bloodstream infections caused by Acinetobacter spp. in newborns who were at KCMC, Tanzania. Elevated mortality was linked to high rates of multidrug resistance, including carbapenem resistance, especially in low birth weight and sick newborns. These results underscore the crucial need for robust antimicrobial stewardship programs, enhanced infection control measures, and revision of empirical therapies in newborn care facilities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to the management of Kilimanjaro Christian Medical Centre for permitting us to access its hospital’s medical records and providing an exemplary environment during data collection. We thank all clinicians and laboratory personnel for their various forms of support throughout this phase.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.G.M., A.S., E.M.N., and M.M. contributed to study conception and design. F.E.L., E.K. and A.N. did the clinical data collection. M.K., J.M., A.M. and PM supported laboratory collection, analysis and data validation. F.S. and N.P. did the statistical analysis of all the study data and report writing. A.G.M., M.K., C.J. and M.M. were involved in drafting this manuscript. B.T.M., A.S., A.G.M., and M.M. interpreted the data and critically reviewed the manuscript. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data generated is included in this manuscript. However, the corresponding author can share any information upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission to write the report was granted by the Kilimanjaro Christian Medical University College Research Ethics Review Committee (CRERC).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMigamba SM, Kisaakye E, Komakech A, Nakanwagi M, Nakamya P, Mutumba R, et al. Trends and spatial distribution of neonatal sepsis, Uganda, 2016\u0026ndash;2020. BMC Pregnancy Childbirth. 2023;23(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eFleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, et al. Global incidence and mortality of neonatal sepsis: A systematic review and meta-analysis. Arch Dis Child. 2021;106(8):745\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eSokou R, Tavoulari EF, Qian K, Li Jie, Shen L. 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Bacteria. 2024;3(2):76\u0026ndash;98.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Acinetobacter spp. bloodstream infection, neonatal sepsis, multidrug resistance, carbapenem resistance, antimicrobial stewardship, infection prevention and control, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-8370266/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8370266/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cem\u003eAcinetobacter spp.\u003c/em\u003e bloodstream infections (BSIs) are an emerging cause of neonatal sepsis, yet data from sub-Saharan Africa are scarce. We retrospectively reviewed neonates admitted to the Kilimanjaro Christian Medical Centre Neonatal unit, Tanzania, from 2021 to June 2024, with blood culture confirmed \u003cem\u003eAcinetobacter spp.\u003c/em\u003e BSI. Of 421 Gram negative bacteria isolated from the 2901 blood cultures processed, 33 (7.8%) were \u003cem\u003eAcinetobacter spp..\u003c/em\u003e Median age at presentation was 4 days (IQR 2\u0026ndash;7), and case fatality was 42.4%. Multidrug resistance (MDR) occurred in 60.6% of isolates, and carbapenem resistance in 44%. Mortality was significantly higher in MDR cases (78.6% vs. 15.4%, p\u0026thinsp;=\u0026thinsp;0.045) and carbapenem-resistant cases (70.0% vs. 15.4%, p\u0026thinsp;=\u0026thinsp;0.005). MDR infection was more frequent in neonates admitted with septic conditions (65.0%) or combined septic and respiratory conditions (100%) than with respiratory conditions alone (14.3%). Empirical treatment with more than two antibiotics, or regimens excluding the standard ampicillin and gentamicin combination, was also associated with MDR infection. These findings reveal high mortality and extensive resistance in the isolated \u003cem\u003eAcinetobacter spp.\u003c/em\u003e, including the second line agents, underscoring the urgent need for targeted infection prevention, stewardship interventions.\u003c/p\u003e","manuscriptTitle":"Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:47:41","doi":"10.21203/rs.3.rs-8370266/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"316144823288865078411508319439404592683","date":"2026-02-17T07:33:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113883194736586009622355365056810899000","date":"2026-02-15T21:03:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-15T15:15:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327843459239306810366057520510532427428","date":"2026-02-10T09:18:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334673175416876269537771439231069981372","date":"2026-02-06T17:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T08:35:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T08:41:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-19T07:09:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-19T07:06:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-12-15T22:39:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3aa3ff4-d16c-4233-883e-3143d6f6ecb6","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T12:47:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:47:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8370266","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8370266","identity":"rs-8370266","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}