Format

Send to

Choose Destination
Arch Dis Child. 2020 Jan;105(1):26-31. doi: 10.1136/archdischild-2019-316816. Epub 2019 Aug 24.

Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.

Author information

1
Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK.
2
Paediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital, Basel, Switzerland.
3
Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
4
Santa Casa Medical School, São Paulo, Brazil.
5
Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
6
Instituto Fernandes Figueira, Rio de Janeiro, Brazil.
7
Federal Fluminense University, Rio de Janeiro, Brazil.
8
Prontobaby Children's Hospital, Rio de Janeiro, Brazil.
9
Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia.
10
Angkor Hospital for Children, Siem Reap, Cambodia.
11
Fundación Valle del Lili, Santiago de Cali, Colombia.
12
Shenzhen Children's Hospital, Shenzhen, China.
13
Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece.
14
Attikon University General Hospital, Athens, Greece.
15
School of Health Sciences, Aristotle University, Thessaloniki, Greece.
16
Department of Paediatrics, Rural Development Trust Hospital, Bathalapalli, India.
17
Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
18
Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India.
19
Department of Neonatology, Fernandez Hospital, Hyderabad, India.
20
Amrita Institute of Medical Sciences, Kochi, India.
21
Kasturba Medical College, Manipal, India.
22
Lady Hardinge Medical College, New Delhi, India.
23
All India Institute of Medical Sciences, New Delhi, India.
24
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
25
International Foundation Against Infectious Disease in Nigeria, Omaha, Nebraska, USA.
26
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
27
Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
28
National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
29
University of the Witwatersrand, Johannesburg, South Africa.
30
Chulalongkorn University, Bangkok, Thailand.
31
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
32
Queen Sirikit National Institute of Child Health, Bangkok, Thailand.
33
Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
34
Department of Paediatrics, Khon Kaen University, Khon Kaen, Thailand.
35
Phayao Hospital, Phayao, Thailand.
36
Paediatrics and Child Health, Makerere University, Kampala, Kampala, Uganda.
37
Mulago Hospital, Kampala, Uganda.
38
Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden - Vietnam, Hanoi, Vietnam.
39
Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK msharlan@sgul.ac.uk.

Abstract

OBJECTIVE:

To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR).

DESIGN:

A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns.

SETTING:

39 NNUs from 12 countries.

PATIENTS:

Any neonate admitted to one of the participating NNUs.

INTERVENTIONS:

This was an observational cohort study.

RESULTS:

The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%.

CONCLUSION:

AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.

KEYWORDS:

antimicrobial resistance; neonatal sepsis

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center