Bloodstream infections (BSIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs) across Malaysia, and ongoing efforts to monitor, prevent, and control these infections continue to face challenges. Since 2008, the Malaysian National Neonatal Registry (MNNR) has made significant progress in enhancing the collection of BSI data, including detailed tracking of central venous line infections, meningitis, and classification of organisms by early- and late-onset sepsis. Despite improvements in data quality and antimicrobial resistance surveillance, issues with data entry and accuracy remain and require further refinement.

A 2020 review examined late-onset sepsis (LOS) and central line–associated bloodstream infections (CLABSI) in neonates born at <32 weeks’ gestation within the MNNR network. LOS rates were 1.4 per 1,000 patient-days, while CLABSI rates were 3.7 per 1,000 catheter-days (limited to the duration of the longest in-situ catheter). Notably, some centres achieved low infection rates despite high workloads, highlighting opportunities for quality improvement.

Using data from 2015–2020, the MNNR has published two papers addressing early-onset sepsis (EOS) and LOS in Malaysian NICUs. The incidence of EOS was 0.48 per 1,000 live births—lower than pre-2015 rates in high-income countries. Among very low birth weight (VLBW) infants, the incidence was higher at 16.1 per 1,000. Group B Streptococcus (GBS) and Escherichia coli were the predominant pathogens. Risk factors for GBS EOS included Indian ethnicity and chorioamnionitis, while outborn status and extremely low birth weight (ELBW) were associated with non-GBS EOS.

For LOS, the overall incidence has declined but remains stable in ELBW and extremely preterm neonates, averaging 4.9 per 100 admissions in VLBW infants. Common pathogens included coagulase-negative staphylococci (CoNS), Klebsiella spp., Staphylococcus aureus, Pseudomonas spp., and Acinetobacter spp. The mortality rate was 30%, with particularly high mortality linked to gram-negative and fungal infections, especially in cases of meningitis. Risk factors for LOS included extreme prematurity, small for gestational age (SGA), mechanical ventilation, total parenteral nutrition (TPN), and central venous lines. Mortality risk factors included SGA status, mechanical ventilation, gram-negative and fungal infections, and pneumothorax. Interestingly, TPN use was associated with lower mortality.

Future directions include implementing universal antenatal GBS screening, improving infection control for outborn and ELBW neonates, reducing CLABSI rates, strengthening antimicrobial stewardship, and expanding quality improvement initiatives.