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

Background: Pathogens causing neonatal sepsis have developed resistance to antimicrobial treatment, resulting in the convergence of two public health issues; neonatal mortality and antimicrobial resistance. There are a few published studies presenting data from South Africa regarding neonatal sepsis pathogen and resistance profiles. Methods: We conducted a systematic review of bacterial and fungal neonatal sepsis pathogens and antimicrobial resistance profiles from 2005 to 2022. Results: Nine studies were included from 1235 screened. Most studies were from two provinces in South Africa and were conducted at academic hospitals. A single study included data collected nationally. Significant heterogeneity was noted, precluding the value of conducting a formal meta-analysis. There was significant variability in prevalence of pathogens, dependent on whether studies included coagulase negative Conclusion: The prevalence of pathogens causing neonatal sepsis in South Africa are consistent with those on the WHO list of priority bacterial and fungal pathogens. A high percentage resistance to WHO first and second line treatment is noted and emphasizes the importance of country specific surveillance for neonatal sepsis.