Paediatrica Indonesiana p-ISSN 0030-9311.
e-ISSN 2338-476X.
Vol.
No.
DOI: https://doi.
org/10.
14238/pi65.
Original Article Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients in Dr.
Abdul Moeloek Hospital.
Lampung Leni Ervina1.
Hendri Busman2.
Khairunnisa Berawi2.
Bambang Irawan2.
Nailul Azizah1.
Jennifer Ester Yolanda1 Abstract Background Neonatal infections cause more than 550,000 deaths each year worldwide.
Sepsis is a serious neonatal infection, defined as a severe form of infection that causes organ dysfunction.
The incidence of neonatal sepsis in Dr.
Abdul Moeloek Hospital.
Lampung, increased by 25% from 2017 to 2018 and by 30% from 2018 to 2019.
Inappropriate use of antibiotics as therapy can lead to bacterial resistance to the medication.
Understanding the most common bacterial patterns and using the guidance of antibiotic sensitivity tests can help health workers determine the empirical antibiotics needed to achieve optimal management, especially in neonatal sepsis patients.
Objective To identify bacteria and their antibiotic sensitivity patterns in neonatal sepsis patients at Dr.
Abdul Moeloek Hospital.
Lampung between January and June 2024.
Method Descriptive study was conducted using medical record data from neonates suspected of having sepsis in Dr.
Abdul Moeloek Hospital Lampung between January and June 2024.
Blood culture data and antibiotic sensitivity testing was obtained from medical records.
Results Of 65 blood culture of neonates suspected of having sepsis, 31 results were positive .
6%).
The most common microorganisms found were Klebsiella pneumoniae .
%).
Burkholderia cepacia .
%).
Acinetobacter baumannii .
%).
Pseudomonas aeruginosa .
%).
Enterococcus faecium .
%) Staphylococcus aureus .
%).
Staphylococcus epidermidis .
%).
Enterococcus faecalis .
%).
Escherichia coli .
%), and Enterobacter cloacae .
%).
Based on the sensitivity data calculated using weighted averages, ciprofloxacin .
7%) and tigecycline .
showed highest sensitivity across more than five bacterial species.
In contrast, ampicillin/sulbactam .
0%), gentamicin .
2%),
and ceftriaxone .
7%) had the highest resistance rates.
Conclusion The most common bacteria causing neonatal sepsis were Klebsiella pneumoniae and Burkholderia cepacia.
Among more than five bacterial species, the highest overall sensitivity was observed to ciprofloxacin and tigecycline, while the highest resistance rates were observed to ampicillin/sulbactam, gentamicin, and ceftriaxone.
[Paediatr Indones.
65:297-306.
DOI: https://doi.
org/10.
297-306 ].
Keywords: bacterial patterns.
antibiotic sensitivity.
neonatal sepsis.
blood culture nfection is one of the leading causes of infant mortality worldwide.
According to the WHO, neonatal infections are mainly caused by bacteria, and result in more than 550,000 deaths each year.
1 In Indonesia, 18,281 neonatal deaths were recorded throughout 2022.
2 According to LampungAos health profile data in 2022, the number of neonatal deaths reached 451 neonates, of which 17 .
were caused by infection.
Infections in neonates are generally caused by bacteria and viruses, and rarely by fungi or parasites.
3 The WHO reported the most From Dr.
Abdul Moeloek Regional Hospital1 and Doctoral Program.
Faculty of Mathematics and Natural Sciences.
Universitas Lampung2.
Lampung.
Indonesia.
Corresponding author: Leni Ervina.
Dr.
Abdul Moeloek Regional Hospital.
Lampung.
Jl.
Dr.
Rivai No.
Bandar Lampung.
Lampung.
Indonesia.
Email: ervinaleni@yahoo.
Submitted March 3, 2025.
Accepted August 14, 2025.
Paediatr Indones.
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July 2025 A 297 Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients common diagnosis, such as pneumonia, sepsis, and meningitis, are mostly caused by bacteria.
Diagnosis of infection in neonates includes two important components: clinical manifestations .
btained from history-taking and physical examinatio.
and supporting examinations.
Clinical manifestations in neonates who experience infection vary greatly, depending on the affected organs, potentially involving the bloodstream, lungs, heart, meninges, urinary tract, peritoneum, digestive organs, conjunctivae, and skin.
4 Signs and symptoms of patients can include temperature instability, tachycardia, apnea or tachycardia, hypotension, irritability, bleeding, lethargy, and symptoms of poor perfusion such as pallor and cyanosis.
5 However, clinical manifestations of infection in neonates are generally nonspecific.
This makes establishing the diagnosis of infection in neonates challenging for medical personnel.
6 Therefore, supporting examinations play an important role in determining the diagnosis of infection in neonates.
One serious neonatal infection is sepsis, which is defined as a severe form of infection in which the body experiences dysregulation, causing organ 7 The WHO .
stated that there were an estimated 1.
3 to 2.
9 million cases of neonatal sepsis and 400,000 to 700,000 deaths each year worldwide.
In addition, 84% of neonatal sepsis patient deaths due to infection can be prevented with early diagnosis and appropriate clinical management.
8 A previous study at Dr.
Abdul Moeloek Hospital.
Lampung, found the incidence of neonatal sepsis was increased every year from 2017 to 2019, with 193 cases in 2017, 242 cases in 2018, and 317 cases in 2019.
This represents an increase in the number of neonatal sepsis cases by 25% from 2017 to 2018 and 30% from 2018 to 2019.
In general, the diagnosis of neonatal sepsis is confirmed by clinical manifestations and supporting Complete blood count.
C-reactive protein (CRP), blood culture, urine culture, procalcitonin (PCT), interleukin-8 (IL-.
, and lumbar puncture are laboratory tests that can be performed to diagnose neonatal sepsis.
The blood culture is the gold standard.
10 Although several studies stated that blood culture is time-consuming and tends to give false negative results, it remains the gold standard evaluation for neonatal sepsis because of itsAo ability to identify the causative agent of infection, which further 298 A Paediatr Indones.
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July 2025 facilitates medical personnel in determining the appropriate antibiotic to be given to each patient.
Several studies from different countries over the past 13 years have stated that Klebsiella spp.
Staphylococcus spp.
were the two most common types of bacteria found in patients with neonatal sepsis.
A 2023 study conducted in West Sumatra.
Indonesia found that Klebsiella pneumoniae and Staphylococcus haemolyticus were the most common causative agents of neonatal sepsis.
16 This shows that over time, the types of bacteria that cause neonatal sepsis in several countries around the world remain largely similar.
A previous study conducted at the same hospital as our study, noted that in the Perinatology Unit.
Klebsiella were the most common type of bacteria isolated .
%), followed by Staphylococcus spp.
9%),
Pseudomonas spp.
%), and Proteus spp.
5%).
Antibiotics are the most widely used drugs to treat neonatal sepsis.
However, the use of antibiotics is often inappropriate, resulting in the development of resistant strains.
Pathogen resistance to many antibiotics impedes the successful management of neonatal sepsis patients.
18 Identifying antibiotics to which the bacteria have high sensitivity is crucial in improving neonatal sepsis management.
A 2023
Balinese study stated that ampicillin and gentamicin remain to be the empirical therapies for neonatal A study in Suzhou.
China reported that gram-positive bacteria such as Staphylococcus aureus.
Staphylococcus epidermidis.
Staphylococcus haemolyticus were sensitive to vancomycin, tigecycline, and teicoplanin and resistant to penicillin, oxacillin, and erythromycin.
20 Meanwhile, gramnegative bacteria such as Klebsiella pneumoniae and Escherichia coli were sensitive to carbapenems, quinolones such as ciprofloxacin, and levofloxacin, as well as aminoglycosides such as gentamicin and Some of these antibiotics resemble the results of a study from West Sumatra.
Indonesia, which reported that Staphylococcus haemolyticus was sensitive to vancomycin, tigecycline, nitrofurantoin, linezolid, and quinupristin/dalfopristin, while Klebsiella pneumoniae was sensitive to tigecycline, meropenem, ertapenem, and amikacin.
On the other hand, a study at Dr.
Abdul Moeloek Hospital Lampung found that the four most common types of bacteria, namely Klebsiella spp.
Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients Staphylococcus spp.
Pseudomonas spp.
, and Proteus had the highest sensitivity to meropenem.
Furthermore, the most prevalent resistance pattern in the four most common bacteria was against Although there are many similarities in bacterial patterns and antibiotic sensitivities across regions and countries, bacterial patterns and antibiotic sensitivities can change over time.
These changes in bacterial patterns can affect antibiotic selection.
In addition, changes in bacterial sensitivity to antibiotics can also affect patient prognosis.
We aimed to identify bacteria and the antibiotic sensitivity patterns in neonatal sepsis patients at Dr.
Abdul Moeloek Hospital.
Lampung between January and June 2024.
Our findings can help healthcare providers empirically select antibiotics for neonatal sepsis patients at Dr.
Abdul Moeloek Hospital.
Lampung to ultimately improve patient management in an effort to reduce morbidity and mortality in infants, especially in Indonesia.
Methods This descriptive study was conducted in neonatal sepsis patients between January and June 2024.
Data were obtained from patient medical records at Dr.
Abdul Moeloek Hospital.
Lampung.
The inclusion criteria were neonates suspected of having sepsis who underwent culture examinations and antibiotic sensitivity testing on blood specimens.
Patients with incomplete medical records were excluded.
The data obtained were collected and processed using Microsoft Excel.
The percentage of isolate sensitivity or resistance to a given antibiotic was calculated by dividing the number of isolates of a specific bacterial species that were sensitive or resistant to the antibiotic .
by the total number of isolates of that species tested against the antibiotic .
Overall sensitivity and/or resistance rates for each antibiotic were calculated using a weighted average method, in which the percentage for each organism was multiplied by the number of isolates tested, and then divided by the total number of isolates tested for that antibiotic.
Sensitivity and/or resistance rates were not calculated for bacterial types represented by a single isolate, due to insufficient sample size.
Results Of 65 blood culture examinations of neonates suspected of sepsis, 31 results were positive .
6%).
The most common microorganisms found were Klebsiella pneumoniae .
%).
Burkholderia cepacia .
%).
Acinetobacter baumannii .
%).
Pseudomonas aeruginosa .
%).
Enterococcus faecium .
%).
Staphylococcus aureus .
%).
Staphylococcus epidermidis .
%).
Enterococcus faecalis .
%).
Escherichia coli .
%), and Enterobacter cloacae .
%) (Table .
Table 2 shows the antibiotic sensitivities of the various bacteria cultured from subjects, while Table 3 shows the antibiotic resistances.
Klebsiella pneumoniae was most sensitive to ciprofloxacin .
4%, 5/7 isolates teste.
, tigecycline .
7%, 4/6
isolates teste.
, and trimethoprim/sulfamethoxazole .
%, 3/5 isolates teste.
Meanwhile, it exhibited 100% resistance to almost all beta-lactam group antibiotics .
mpicillin, amoxicillin, penicillin, ticarcillin, imipenem, doripenem, cefazolin, cefadroxil, cefoperazone, cefoxitin, cefuroxime, and oxacilli.
, except for meropenem with 66.
7% resistance .
of 6 teste.
It also exhibited 100% resistance to the macrolide group .
rythromycin, azithromycin, clarithromyci.
, quinolone group .
floxacin and levofloxaci.
, aminoglycosides group .
, glycopeptides group .
, tetracycline group .
, and other antibiotics .
uinupristin, fosfomycin, rifampicin, and linezoli.
Burkholderia cepacia exhibited good sensitivity to ceftazidime, meropenem, and trimethoprim/ Table 1.
Types of bacteria causing sepsis Types of bacteria, n (N=.
Klebsiella pneumoniae Burkholderia cepacia Acinetobacter baumannii Pseudomonas aeruginosa Enterococcus faecium Staphylococcus aureus Staphylococcus epidermidis Enterococcus faecalis Escherichia coli Enterobacter cloacae Paediatr Indones.
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July 2025 Ofloxacin Meropenem Nitrofurantoin Levofloxacin Linezolid Imipinem Antibiotic sensitivity, % Genta high level .
Gentamicin Fosfomycin Ertapen Erythromycin Doxycycline Doripenem Clarithromycin Ciprofloxacin Cefuroxime Ceftazidime Ceftriaxone Cefoxitin Cefotaxime Cefoperazone Cefepime Cefixime Cefadroxil Cefazolin Aztreonam Azithromycin Amoxicillin Ampicillin/sulbactam Amikacin Ampicillin Antibiotics Table 2.
Antibiotic sensitivity patterns Overall sensitivity, % Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients Vancomycin Trimethoprim/sulfamethoxazole Ticarcillin/clavulanic Ticarcillin Streptomycin high level .
Tetracycline Oxacillin Penicillin Tigecycline Antibiotics Table 2.
Antibiotic sensitivity patterns Rifampicin Quinupristin Piperacillin tazobactam Antibiotic sensitivity, % Overall sensitivity, % Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients sulfamethoxazole .
% for al.
On the other hand, it exhibited 100% resistance to some antibiotics from the aminoglycoside group .
mikacin, gentamici.
, penicillin group .
ztreonam and piperacilli.
, and cephalosporin group .
efepime and ceftriaxon.
Acinetobacter baumannii exhibited high sensitivity to ciprofloxacin .
%), followed by ceftazidime and trimethoprim/sulfamethoxazole with 67% each.
Meanwhile.
baumannii cultures were resistant to gentamicin .
%) and meropenem .
%).
Pseudomonas aeruginosa was most sensitive to cefepime and ceftazidime, with 67% each, and showed 100% resistance to ampicillin/sulbactam, tigecycline, and Enterococcus faecium isolates were susceptible .
%) to amikacin, linezolid, tigecycline, vancomycin, and exhibited no high-level resistance to Meanwhile, it exhibited 100% resistance to the penicillin group .
mpicillin, ampicillin/ sulbactam, amoxicillin, aztreonam, ertapenem, imipinem, and meropene.
, cephalosporin group .
efepime, cefotaxime, ceftazidime, and ceftriaxon.
, macrolide group .
, aminoglycoside group .
, quinolone group .
, and other .
rimethoprim, tazobacta.
Enterococcus faecalis was most sensitive to doxycycline, linezolid, nitrofurantoin.
Enterococcus faecalis isolates demonstrated the highest sensitivity .
%) to doxycycline, linezolid, nitrofurantoin, tigecycline, and vancomycin.
Furthermore, all isolates lacked high-level resistance to streptomycin.
Meanwhile, it was 100% resistant to ampicillin/sulbactam.
Staphylococcus aureus was most sensitive to tetracycline .
%), but 100% resistant to the betalactam group antibiotics.
Staphylococcus epidermidis exhibited high sensitivity to tetracycline, quinupristin, doxycycline, linezolid, nitrofurantoin, and tigecycline .
% for al.
Meanwhile, it exhibited 100% resistance to the beta-lactam group antibiotics.
Based on the overall sensitivity data calculated using weighted averages, ciprofloxacin .
%) and tigecycline .
%) showed the highest sensitivity across more than five bacterial species.
In contrast, ampicillin/sulbactam .
%), gentamicin .
%), and ceftriaxone .
%) had the highest resistance rates.
Paediatr Indones.
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July 2025 Ofloxacin Oxacillin Meropenem Nitrofurantoin Levofloxacin Linezolid Imipinem Gentamicin Genta high level .
Ertapenem Fosfomycin Doripenem Doxycycline Clarithromycin Erythromycin Ceftriaxone Cefuroxime Ceftazidime Ciprofloxacin Cefoxitin Cefoperazone Cefotaxime Antibiotic resistance, % Cefixime Cefepime Aztreonam Azithromycin Amoxicillin Cefazolin Cefadroxil Ampicillin Amikacin Ampicillin/sulbactam Antibiotics Table 3.
Antibiotic resistance patterns Overall Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients Tigecycline Trimethoprim/sulfamethoxazole Vancomycin Ticarcillin/clavulanic Streptomycin high level .
Tetracycline Rifampicin Ticarcillin Quinupristin Penicillin Piperacillin tazobactam Antibiotic resistance, % Antibiotics Table 3.
Antibiotic resistance patterns Discussion Overall Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients In this study, 47.
6% of subjects had blood cultures with positive bacterial growth.
This result was lower than a previous study at our facility, which showed 69% positive growth.
17 Our lower positive culture results could have been influenced by several factors, such as our small sample size, bacteria that are difficult to grow to culture except in media with specialized nutritional requirements, specimen collection methods, inadequate blood volume, methods used, or patient selection criteria for blood cultures that varied from hospital to hospital.
Klebsiella pneumoniae, a gram-negative, nonmotile, and typically encapsulated bacillus from the Enterobacteriaceae family, is a dominant pathogen in neonatal sepsis.
Local infections or colonization of the urinary tract, gastrointestinal tract, or respiratory tract often spread into the bloodstream.
22 The most common microorganism in neonatal sepsis patients was Klebsiella pneumoniae .
%).
This aligned with two previous studies at our facility, which identified Klebsiella pneumoniae as the most common cause of sepsis .
4# and 30.
Furthermore, hospital studies found Klebsiella sp.
2% of cases in Padang,24 46.
4% of cases in Africa,25 and 16.
2% of cases in Jakarta.
Klebsiella pneumoniae was found most sensitive to ciprofloxacin .
43%), tigecycline .
67%), and trimethoprim/sulfamethoxazole .
%).
This differed from a previous study at Dr.
Abdul Moeloek Hospital.
Lampung, where K.
pneumoniae was most sensitive to tigecycline .
5%), meropenem .
%), and amikacin .
%).
24 This difference might have been caused by the emergence of resistant strains due to irrational use of antibiotics.
17 Klebsiella pneumoniae was most resistant to antibiotics that belong to the beta-lactam group.
This could be attributed to pneumoniaeAos ability to produce enzyme known as ESBL .
xtended-spectrum beta lactamas.
that hydrolyzes beta-lactam antibiotics containing oxyimino groups, such as ceftazidime, ceftriaxone, cefotaxime or aztreonam.
Burkholderia cepacia exhibited good sensitivity to ceftazidime, meropenem, and trimethoprim/ sulfamethoxazole, all at 100%.
Similar findings were reported, where Burkholderia cepacia most sensitive to meropenem, ceftazidime, trimethoprim/ Paediatr Indones.
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: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients sulfamethoxazole with each 100%.
25 Carbapenem antibiotics, such as meropenem, are the therapeutic option for Burkholderia cepacia.
On the other hand.
Burkholderia cepacia exhibits the highest resistance to beta lactam antibiotics because it contains modified lipopolysaccharides, which lead to intrinsic polymyxin Acinetobacter baumannii has high sensitivity to ciprofloxacin .
%), followed by ceftazidime and trimethoprim/sulfamethoxazole .
ith 67% eac.
, and amikacin .
3%).
Acinetobacter baumannii had 50% sensitivity to amikacin.
27 Similar findings were reported by a study in Doha.
baumannii was most sensitive to amikacin and meropenem, both at 100%.
baumannii was also resistant to gentamicin .
%) and meropenem .
%).
27 This aligned with a study that reported that A.
baumannii was resistant to meropenem .
3%).
25 Pseudomonas aeruginosa was most sensitive to cefepime and ceftazidime, each with Similar findings were reported by in a previous study, with cefepime sensitivity at 46% and ceftazidime at 75%.
Meanwhile.
Pseudomonas aeruginosa was 100% resistant to ampicillin/sulbactam, tigecycline, and piperacillin.
aeruginosa was most resistant to penicillin group antibiotics, with 96%.
Enterococcus faecium isolates were susceptible .
%) to amikacin, linezolid, tigecycline, vancomycin, and exhibited no high-level resistance to streptomycin.
However, it was resistant to penicillin and cephalosporin antibiotics.
Enterococcus faecalis isolates demonstrated the highest sensitivity .
%) to doxycycline, linezolid, nitrofurantoin, tigecycline, and vancomycin.
Furthermore, all isolates lacked high-level resistance to streptomycin.
However, it was 100% resistant to ampicillin/sulbactam.
Serious enterococcal infections are often difficult to treat because the organisms show intrinsic resistance to a variety of antibiotics, including penicillins, cephalosporins, and sometimes to aminoglycosides, clindamycin, and lincosamides.
Staphylococcus aureus was most sensitive to tetracycline .
%).
Staphylococcus epidermidis exhibited high sensitivity to tetracycline, quinupristin, doxycycline, linezolid, nitrofurantoin, tigecycline .
% for al.
Meanwhile.
Staphylococcus sp.
100% resistance to the beta-lactam group antibiotics.
Similar findings were reported by a previous study which reported that tetracycline had a sensitivity of 304 A Paediatr Indones.
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Based on the overall sensitivity data calculated using weighted averages, ciprofloxacin .
%) and tigecycline .
%) showed the highest sensitivity across more than five bacterial species.
Based on the bacterial type, gram-negative bacteria were most sensitive to ceftazidime, cefepime, meropenem, tigecycline, ciprofloxacin, and trimethoprim/sulfamethoxazole.
Meanwhile, gram-positive bacteria were most sensitive to doxycycline, linezolid, tetracycline, and tigecycline.
On the other hand, the highest overall resistance were observed in bacterial isolates against ampicillin/ sulbactam .
%), gentamicin .
%), and ceftriaxone .
%).
To date, the first line of antibiotics previously recommended by the WHO were a combination of narrow-spectrum penicillins .
uch as penicillin, ampicillin, or amoxicilli.
and aminoglycosides .
uch as gentamicin or amikaci.
5 In Indonesia, ampicillin and gentamicin are still empirical therapies for neonatal sepsis.
19 However, the results of this study showed that the highest resistance was observed in isolates against ampicillin/sulbactam .
%) and gentamicin .
%).
pneumoniae and E.
demonstrated 100% resistance to ampicillin, whereas faecalis showed 50% resistance.
With the results showing high resistance, the use of ampicillin/sulbactam and gentamicin should be reconsidered in treating neonatal sepsis, particularly at Dr.
Abdul Moeloek Hospital in Lampung.
However, because these data were primarily from the Lampung province, the results were influenced by local epidemiological conditions.
Additionally, the relatively small sample size may not provide results that are truly representative in a broader context.
Therefore, further research related to bacterial patterns and antibiotic sensitivity needs to be conducted routinely, with larger sample size, across various places, and at certain intervals, so that the treatment of neonatal sepsis remains as effective as possible for future sepsis patients.
In conclusion, the most common bacteria causing neonatal sepsis were Klebsiella pneumoniae and Burkholderia cepacia.
Among more than five bacterial species, the highest overall sensitivity was observed to ciprofloxacin and tigecycline, while the Leni Ervina et al.
: Bacterial patterns and antibiotic sensitivity among neonatal sepsis patients highest resistance rates were observed to ampicillin/ sulbactam, gentamicin, and ceftriaxone.
Conflict of interest None declared.
Funding acknowledgement The authors received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.
References