Morbidity and mortality associated with Acinetobacter spp. bloodstream infection at a tertiary hospital in northern Tanzania: a call for strict infection prevention and control measures in the neonatal unit

Acinetobacter spp. bloodstream infections (BSIs) are an emerging cause of neonatal sepsis, yet data from sub-Saharan Africa are scarce. We retrospectively reviewed neonates admitted to the Kilimanjaro Christian Medical Centre Neonatal unit, Tanzania, from 2021 to June 2024, with blood culture confirmed Acinetobacter spp. BSI. Of 421 Gram negative bacteria isolated from the 2901 blood cultures processed, 33 (7.8%) were Acinetobacter spp.. Median age at presentation was 4 days (IQR 2–7), and case fatality was 42.4%. Multidrug resistance (MDR) occurred in 60.6% of isolates, and carbapenem resistance in 44%. Mortality was significantly higher in MDR cases (78.6% vs. 15.4%, p = 0.045) and carbapenem-resistant cases (70.0% vs. 15.4%, p = 0.005). MDR infection was more frequent in neonates admitted with septic conditions (65.0%) or combined septic and respiratory conditions (100%) than with respiratory conditions alone (14.3%). Empirical treatment with more than two antibiotics, or regimens excluding the standard ampicillin and gentamicin combination, was also associated with MDR infection. These findings reveal high mortality and extensive resistance in the isolated Acinetobacter spp. , including the second line agents, underscoring the urgent need for targeted infection prevention, stewardship interventions.