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. 2025 Feb 21;14(1):15.
doi: 10.1186/s13756-025-01520-x.

A mixed-method study on antimicrobial resistance infection drivers in neonatal intensive care units: pathways, risks, and solutions

Almaw Genet Yeshiwas  1 , Gashaw Melkie Bayeh  1 , Tilahun Degu Tsega  2 , Sintayehu Simie Tsega  3 , Asay Alamneh Gebeyehu  4 , Zufan Alamrie Asmare  5 , Rahel Mulatie Anteneh  4 , Amare Genetu Ejigu  6 , Ahmed Fentaw Ahmed  2 , Zeamanuel Anteneh Yigzaw  7 , Abathun Temesgen  1 , Anley Shiferaw Enawgaw  8 , Getasew Yirdaw  9 , Wosenyelesh Desalegn  10 , Chalachew Yenew #  11
Affiliations

A mixed-method study on antimicrobial resistance infection drivers in neonatal intensive care units: pathways, risks, and solutions

Almaw Genet Yeshiwas et al. Antimicrob Resist Infect Control. .

Abstract

Background: Antimicrobial resistance (AMR) in neonatal intensive care units (NICUs) complicates treatment of healthcare-associated infections, causing high morbidity and mortality, especially among low-birth-weight and critically ill infants. This study evaluates AMR prevalence, risk factors, outcomes and infection control measures at Felege Hiwot Hospital, aiming to guide clinical practices, antimicrobial stewardship, and improved neonatal health outcomes.

Methods: This mixed-methods study (Oct 2022-Jun 2023) assessed AMR in NICU neonates by analyzing 420 blood samples, environmental swabs, and staff insights. Bivariable and multivariable regressions identified significant variables, and content analysis was used for qualitative data.

Results: Out of 420 samples, 35% tested positive for AMR pathogens, with Coagulase-Negative Staphylococci (16.7%), Klebsiella pneumoniae (12.9%), and Acinetobacter spp. (5.6%) being the most prevalent. Resistance rates for Gentamicin, Cotrimoxazole, and Ciprofloxacin were alarmingly high (98-100%), while Amikacin demonstrated low resistance (3.0-5.56%), indicating potential efficacy. Among the neonates admitted, 91.8% survived, and 8.2% succumbed. Risk factor analysis revealed that improper PPE usage (AOR 3.90, p < 0.001), non-functional handwashing sinks (AOR 3.20, p < 0.001), and inadequate disinfection practices (AOR 2.70, p < 0.001) were strongly associated with microbial contamination. Environmental factors, including cockroach presence (AOR 1.80, p = 0.040) and high traffic flow (AOR 2.10, p = 0.005), were also significant contributors. The qualitative data analysis confirmed that improper PPE use, inadequate disinfection practices, pest control challenges, and non-functional handwashing sinks significantly contributed to microbial contamination risks in the NICU, aligning with the quantitative findings.

Conclusions: This study underscores key factors driving AMR in NICUs, such as inadequate IPC practices and environmental contamination, alongside high resistance to Cotrimoxazole and Ciprofloxacin. Amikacin shows promise as an effective treatment for CONS. Urgent actions, including strengthened IPC measures, staff training, and environmental management, are crucial to combat AMR, ensuring improved neonatal care and outcomes.

Keywords: Amikacin; Antimicrobial resistance (AMR); Coagulase-negative staphylococci (CONS); Infection prevention and control (IPC); NICU.

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Conflict of interest statement

Declarations. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests. Ethics approval: An ethical letter approval was obtained from the Institutional Review Board (IRB) of GAMBY medical and Business College with a reference number of GMBCRCS/1241, in alignment with the Declaration of Helsinki principles. Furthermore, before the data collection, a formal permission letter was obtained from Amhara Public Health Institute. Similarly, Facility heads was communicated through supporting letters and be informed about the purpose of the study before actual data collection. Data confidentiality was maintained by avoiding possible identifiers such as the name of the study participants with identification numbers.

Figures

Fig. 1
Fig. 1
Antibiotic resistance rates of common pathogens isolated in neonatal care settings
Fig. 2
Fig. 2
outcomes and key causes of neonatal admissions
Fig. 3
Fig. 3
Hand hygiene compliance among healthcare workers, showing access to supplies and adherence to WHO 5 Moments
Fig. 4
Fig. 4
Illustrating the compliance rates for various aseptic practices and device management in the NICU with an ideal compliance threshold of 80%
See this image and copyright information in PMC

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