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Background  Neonatal infection constitutes one of Senegal’s most important public health problems, with a mortality rate of 41 deaths per 1,000 live births.    Methods  Between January 2007 and March 2008, 242 neonates with suspected infection were recruited at three neonatal intensive care units in three major tertiary care centers in Dakar, the capital of Senegal. Neonatal infections were confirmed by positive bacterial blood or cerebrospinal fluid culture. The microbiological pattern of neonatal infections and the antibiotic susceptibility of the isolates were characterized. In addition, the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R)  Enterobacteriaceae  were studied.    Results  A bacteriological infection was confirmed in 36.4 % (88/242) of neonates: 22.7 % (30/132) during the early-onset and 52.7 % (58/110) during the late-onset periods ( p  > 0.20). Group B  streptococci  accounted for 6.8 % of the 88 collected bacterial isolates, while most of them were  Enterobacteriaceae  ( n  = 69, 78.4 %). Of these, 55/69 (79.7 %) were 3GC-R. The  bla   CTX-M-15  allele, the  bla   SHV  and the  bla   TEM  were highly prevalent (63.5, 65.4 and 53.8 %, respectively), usually associated with  qnr  genes (65.4 %). Clonally related strains of 3GC-R  Klebsiella pneumoniae  and 3GC-R  Enterobacter cloacae , the two most commonly recovered 3GC-R  Enterobacteriaceae  (48/55), were detected at the three hospitals, underlining the role of cross-transmission in their spread. The overall case fatality rate was 18.6 %.    Conclusions  Measures should be taken to prevent nosocomial infections and the selection of resistant bacteria.

High third-generation cephalosporin resistant Enterobacteriaceae prevalence rate among neonatal infections in Dakar, Senegal