Abstract
<title>Abstract</title> <p>Background Neonatal sepsis is a major cause of death and serious complication in preterm infants, with higher mortality in low- and middle-income countries where gram-negative pathogens and antimicrobial resistance are prevalent. Data directly comparing the outcomes of sepsis caused by Gram-positive versus Gram-negative bacteria in preterm neonates remain limited. This study aimed to evaluate differences in mortality and short-term morbidities among preterm neonates with culture-proven sepsis caused by gram-positive or gram-negative bacteria. Methods We conducted a retrospective cohort study including preterm infants (28 to < 37 weeks gestation) with blood culture-proven sepsis admitted to the NICU/NHCU of a tertiary hospital in Bandung between January 2024 and December 2025. Infants with mixed bacterial or fungal infections or major congenital anomalies were excluded. The outcomes were mortality and morbidities: necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and intracranial hemorrhage (ICH). Results Eighty-seven preterm infants were included; 29 (33.3%) had gram-positive infections, and 58 (66.7%) had gram-negative infections. The overall mortality rate was 72.4%, which was significantly greater for gram-negative sepsis patients (81.0% vs 55.2%). In contrast, there were no significant differences in NEC (27.6% vs 31.0%), BPD (24.1% vs 19.0%), or ICH (13.8% vs 15.5%) between the groups. Conclusions gram-negative sepsis was associated with increased mortality. The incidence rates of NEC, BPD, and ICH did not differ by pathogen group. These findings highlight the need to optimize empiric therapy and infection prevention strategies targeting gram-negative sepsis in resource-limited neonatal care settings.</p>