Background:
Multidrug-resistant, Gram negative infections particulaly due to Carbapenem resistant organisms (CRO), have increased globally. Few studies have reported on the burden of CRO in infants from hospital settings in Uganda. This study aimed to determine the incidence and mortality rates of culuture-confirmed Gram negative infections, with a special focuson CRO in a neonatal unit.

Methods:
Positive bacterial cultures from the sterile sites of infants admitted in the neonatal clinic from the 1st of January 2018 to 31st December 2019 were reviewed respectively. Type of organism, susceptability and outcomes were recorded. Data on Gram- negative isolates, including the CRO, were extracted, rates and outcomes were analysed.

Results:
There were 2219 neonates with organisms isolated from sterile sites (blood and cerebrospinal fluid), according for all 30% admissions, giving a neonatal sepsis incidence of 17.9/1000 patient-days. There was a total of 1746 positive isolates (excluding coagulase negative staphyloccocus). Of these 1706, (98%) were isolated from blood, and 40 (2%) from cerebrospinal fluid. Overall 1188 (68%) were Gram negative, 371 (21%) Gram-positive and 187 (10.7%) fungal isolates. The common Gram-negatives were Acinetobacter baumannii (526/1188:44%) and klebsiella pneumoniae (469/1188;40%). Carbapenem resistance was observed in 359 (68%) of the Acinetobacter baumannii (CRAB) and in 103 (18%) of the Enterobacterales (CRE) isolates, with 98% of CRE being Klebsiella pneumoniae (CR-klebs). Twenty-four 41% of pseudomonas spiecs were carbapenem resistant.

Conclusion:
We observed a high incidence of positive cultures from sterile sites. The common organism isolated were Gram-negatives, among these carbapenem resistance was high and was associated with high mortality. Mortality was higher in infants with CRE compared to those with Crab.