“Too little too late; low blood culture yields in a tertiary hospital in Nepal”

<b>Setting: </b> Nobel Medical College and Teaching Hospital, Biratnagar, Nepal<b></b> <b>Objective: </b> To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary Neonatal Intensive Care Unit (NICU). <b>Design:</b> This hospital-based, cohort study was followed patients from January to December 2019. <b>Results: </b> Sepsis was suspected in 177 (88%) of the 200 cases admitted in NICU; 52 (29%) were culture positive. <i>Pseudomonas</i> was the predominant organism isolated (40; 78%) followed by coagulase negative <i>staphylococcus</i> (12; 23%). Nine (17%) of the 52 isolates were resistant to Access and Watch group of antibiotics, including some resistance to Reserve group like; imipenem and linezolid. Most treated cases (170; 96%) improved, although 7 (4%) left against medical advice. <b>Conclusion:</b> Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed with Reserve group. Most sepsis was caused by Gram negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care tests, and a greater yield of culture positive results are needed to enhance the management of neonatal sepsis.