This review examines the international (particularly South Asia and Africa) epidemiology, risk factors, diagnostic challenges, and treatment options for multidrug-resistant organism (MDRO) infections causing neonatal sepsis in resource-limited NICUs, covering research over the past decade.
High resistance to WHO first- and second-line treatment regimens has been documented; novel beta-lactam/beta-lactamase inhibitor combinations are effective against several MDROs but cost-prohibitive, while repurposed agents fosfomycin and flomoxef show therapeutic promise.
No primary data are presented — this is a narrative review without systematic methods or pooled quantitative analysis. Pharmacokinetic data in neonates remain sparse, and blood culture sensitivity is low, limiting the evidence base for treatment recommendations.
Clinicians caring for neonates in resource-limited settings should be aware that standard WHO regimens are frequently inadequate for MDRO sepsis, and repurposed agents like fosfomycin may offer a more accessible alternative to expensive novel beta-lactam combinations. International collaboration and national prioritization are urgently needed to close diagnostic and therapeutic gaps.
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