Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network
Open Access
- 1 January 2020
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood
- Vol. 105 (1), 26-31
- https://doi.org/10.1136/archdischild-2019-316816
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
This publication has 17 references indexed in Scilit:
- Culturing rate and the surveillance of bloodstream infections: a population-based assessmentClinical Microbiology & Infection, 2018
- Optimising β -lactam Dosing in Neonates: A Review of Pharmacokinetics, Drug Exposure and PathogensCurrent Pharmaceutical Design, 2018
- Why are preterm newborns at increased risk of infection?Archives of Disease in Childhood: Fetal & Neonatal, 2018
- Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analysesClinical Infectious Diseases, 2017
- Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analysesClinical Infectious Diseases, 2017
- SIgA, TGF-β1, IL-10, and TNFα in Colostrum Are Associated with Infant Group B Streptococcus ColonizationFrontiers in Immunology, 2017
- Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development GoalsThe Lancet, 2016
- Genomic Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care UnitPLOS ONE, 2016
- Access to effective antimicrobials: a worldwide challengeThe Lancet, 2015
- Physicians??? ability to diagnose sepsis in newborns and critically ill childrenPediatric Critical Care Medicine, 2005