The war against drug-resistant microbes is not going very well, warned scientists after a recent study on escalating antibiotic resistance and “superbugs” affecting newborn babies in Southeast Asia, and the resulting often fatal consequences.
Antibiotic resistance has rapidly become a leading cause of death, claiming some 5m lives globally in 2019, reports Science Alert.
That’s already more than the yearly death toll from HIV/Aids or malaria, and the danger of drug-resistant infections is only expected to grow.
According to this most recent study, so-called superbugs can also be alarmingly prevalent in newborn babies, to the point that frontline treatments for sepsis are no longer effective against the majority of bacterial infections.
A team of Australian researchers focused on Southeast Asia for the study, analysing nearly 15 000 blood samples collected from sick infants at 10 hospitals across five regional countries in 2019 and 2020.
Most infections they found involved bacteria unlikely to be subdued by standard treatments. The study revealed high rates of non-susceptibility to commonly prescribed antibiotics recommended by the World Health Organisation (WHO) for neonatal sepsis.
At the 10 hospitals covered in this study, antimicrobial resistance (AMR) was ominously common among disease-causing bacteria, said study co-author Phoebe Williams, a paediatrician at the University of Sydney.
“Our study highlights the causes of serious infections in babies in countries across Southeast Asia with high rates of neonatal sepsis, and shows an alarming burden of AMR that renders many currently available therapies ineffective for newborns," she said.
“Guidelines must be updated to reflect local bacterial profiles and known resistance patterns. Otherwise, mortality rates are only going to keep climbing.”
The situation is compounded by the dearth of new antibiotics in development for babies, said co-author Michelle Harrison, a PhD candidate at the University of Sydney School of Public Health, co-ordinating the research consortium that published the study.
“It takes about 10 years for a new antibiotic to be trialled and approved for babies,” Harrison added, “and with so few new drug candidates in the first place, we need a significant investment in antibiotic development.”
The study found a preponderance of Gram-negative bacteria causing infections in newborns at these hospitals. Due to the structure of their cell envelope, Gram-negative bacteria have an in-built resistance to some antibiotics, and are generally more likely to develop antibiotic resistance than Gram-positive species.
The distinction arises from their different responses to the Gram staining test, which is used to divide bacterial species into these two broad groups based on properties of their cell walls.
Abundant Gram-negative bacteria such as E. coli, Klebsiella, and Acinetobacter were responsible for nearly 80% of infections studied, the authors reported.
“These bugs have long been considered to cause infections only in older babies, but are now infecting babies in their first days of life,” Williams said.
The urgency of neonatal sepsis rarely allows time for lab tests to pinpoint the culprit, so doctors often make educated guesses guided by published research. Much of that research comes from high-income countries, however, limiting its helpfulness in many parts of the world.
These findings highlight the need for more locally relevant data to help doctors quickly identify which treatments are most likely to work, the researchers observed.
“We need more region-specific surveillance to guide treatment decisions. Otherwise, we risk reversing decades of progress in reducing child mortality rates,” Harrison said.
“Our results also revealed fungal infections caused nearly one in 10 serious infections in babies – a much higher rate than in high-income countries," she added. “We need to ensure doctors are prescribing treatments that have the best chance at saving a baby’s life.”
The study was published in The Lancet Regional Health – Western Pacific.
Study details
Pathogen distribution and antimicrobial resistance among neonatal bloodstream infections in Southeast Asia: results from NeoSEAP, a multicentre retrospective study
Benjamin Dicksona, Michelle Harrison, Maria Esterlita Villanueva-Uy et al.
Published in The Lancet Regional Health in September 2025
Summary
Background
Progress in reducing morbidity and mortality due to neonatal sepsis has slowed in recent decades and is threatened by the global rise of antimicrobial resistance. The populous Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance (AMR). Despite this, there remains a lack of robust data on the epidemiology of neonatal sepsis and the prevalence of AMR within the region.
Methods
We evaluated positive blood cultures and susceptibility profiles responsible for neonatal sepsis across 10 clinical sites in five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia, and Vietnam). Retrospective data on all blood cultures collected from neonates over two years (1st January 2019–31st December 2020) were extracted from laboratory records. Data were also collected on the availability and implementation of infection prevention and control resources, and antimicrobial prescribing practices. Pooled estimates across sites and pathogens were generated, with adjustment for clustering.
Findings
Of 14,804 blood cultures collected over the study period, a total of 2131 positive isolates (including 1483 significant pathogens) were identified. Gram-negative bacteria predominated as causative of neonatal sepsis (78·4%; 1163/1483) with Klebsiella spp. (408/1483; 27·5%) and Acinetobacter spp. (261/1483; 17·6%) most frequently isolated overall. Adjusted pooled non-susceptibility for Klebsiella spp. was 86·7% (95% CI 54·0–98·5) for third-generation cephalosporins (ceftriaxone and/or cefotaxime; 3GC) and 17·1% (95% CI 8·1–24·7) for carbapenems; while non-susceptibility for Escherichia coli was 46·4% (95% CI 20·0–72·0) for 3GC and 15·4% (95% CI 2·7–31·0) for carbapenems. Carbapenem non-susceptibility for Acinetobacter spp. was 76·5% (95% CI 59·4–84·5). Gram-positive bacteria accounted for 13·2% (196/1483) of pathogens causative of neonatal sepsis, whilst Candida spp. accounted for 8·3% (123/1483) of culture-positive sepsis episodes.
Interpretation
Neonatal sepsis in tertiary hospitals in Southeast Asia is predominantly caused by gram-negative bacteria, with high rates of non-susceptibility to commonly prescribed antibiotics.
Science Alert article – Study Reveals 'Alarming' Rise of Superbugs in Newborn Babies (Open access)
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