7 Copyright © 2017 by the Academy of Sciences and Arts of Bosnia and Herzegovina. Bacterial sepsis in neonates: Single centre study in a Neonatal intensive care unit in Bosnia and Herzegovina Izeta Sofić 1 , Husref Tahirović 2 , Vincenzo Di Ciommo 3 , Cinzia Auriti 4 Acta Medica Academica 2017;46(1):7-15 DOI: 10.5644/ama2006-124.181 Introduction Neonatal infections currently cause about 1.6 million deaths per year in developing countries. Sepsis and meningitis are respon- sible for most of these deaths (1). Late-on- set sepsis (LOS) is a challenging compli- cation that afects other morbidities, length of hospitalization, cost of care, and mortal- ity rates (2). Improvements in outcome and successful treatment depend largely on early initiation of appropriate antibiotic therapy. Te aetiology of neonatal sepsis in devel- oping countries difers from that in devel- oped countries in the pattern of etiological bacteria and their antibiotic susceptibility (3). In developed countries Group B Strep- tococcus, (GBS) is a common aetiological agent, but the burden in the developing world is less clear (4). Ampicillin and gen- tamicin are used as the frst-line empirical treatment and the decision is traditionally based on the pathogenic fora commonly 1 Department of Paediatrics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina, 2 Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina, 3 Epidemiology Unit, Bambino Gesù Children’s Hospital (IRCCS), Rome, Italy 4 Department of Neonatology, Bambino Gesù, Children’s Hospital (IRCCS), Rome, Italy Correspondence: izeta.sofic@bih.net.ba Tel.: + 387 35 303 714 Fax.: + 387 35 303 740 Received: 30 January 2017 Accepted: 4 May 2017 Key words: Sepsis  Neonatal intensive care unit  Antibiotics. Objective. Te aim of the study was to evaluate the incidence, mortal- ity, risk factors, aetiology and the susceptibility to antibiotics of the bacteria responsible for sepsis. Material and methods. A single cen- tre, prospective, observational study, involving 200 neonates admitted over 12 months to the NICU of the University Children’s Hospital, Tu- zla, Bosnia and Herzegovina. Results. Te crude incidence of all neo- natal sepsis was 68.0% (136/200) and that of late-onset sepsis (LOS) was 48.5% (97/200), yelding an incidence density of LOS of 41.6/1000 patient days. LOS represented the most frequent infection and was sig- nifcantly more frequent than early-onset sepsis (EOS) (71.3% versus 28.7% p<0.001). Te overall mortality was 14.0%, and 18.4% among infected neonates. Risk factors associated with LOS were: mechanical ventilation, intravascular catheter, surgical procedures, birth weight ≤1500 g, gestational age ≤ 28 weeks and Apgar score ≤ 3 at 5 min- utes. Culture proven sepsis developed in 43.4% of neonates. Klebsiella pneumoniae and Enterococcus faecalis were the predominant bacteria. Gram-negative bacteria were susceptible to amikacin, imipenem and meropenem; gram-positive bacteria to vancomycin and amikacin. Conclusion. Neonatal sepsis in our NICU showed a high incidence rate, and gram-negative bacteria were predominant. Low gestational age, mechanical ventilation and an intra-vascular catheter were sig- nifcantly associated with sepsis. It is necessary to develop a multidis- ciplinary approach for routine surveillance of nosocomial infections, to improve the asepsis of therapeutic procedures, and to implement the more appropriate use of antibiotics. Original article