1 Li G, et al. Arch Dis Child 2019;0:1–6. doi:10.1136/archdischild-2019-316816
Original article
Towards understanding global patterns of
antimicrobial use and resistance in neonatal sepsis:
insights from the NeoAMR network
Grace Li,
1
Julia Anna Bielicki,
1,2
A S M Nawshad Uddin Ahmed,
3
Mohammad Shahidul Islam,
3
Eitan Naaman Berezin,
4
Clery B Gallacci,
4
Ruth Guinsburg,
5
Carlos Eduardo da Silva Figueiredo,
6
Rosilene Santarone Vieira,
6
Andre Ricardo Silva,
7
Cristiane Teixeira,
8
Paul Turner,
9
Ladin Nhan,
10
Jaime Orrego,
11
Paola Marsela Pérez,
11
Lifeng Qi,
12
Vassiliki Papaevangelou,
13
Pinelope Triantafyllidou,
14
Elias Iosifidis,
15
Emmanuel Roilides,
15
Kosmas Sarafidis,
15
Dasaratha Ramaiah Jinka,
16
Raghuprakash Reddy Nayakanti,
16
Praveen Kumar,
17
Vikas Gautam,
17
Vinayagam Prakash,
18
Arasar Seeralar,
18
Srinivas Murki,
19
Hemasree Kandraju,
19
Sanjeev Singh,
20
Anil Kumar,
20
Leslie Lewis,
21
Jayashree Pukayastha,
21
Sushma Nangia,
22
Yogesha K N,
22
Suman Chaurasia,
23
Harish Chellani,
24
Stephen Obaro,
25
Angela Dramowski,
26
Adrie Bekker,
26
Andrew Whitelaw,
27,28
Reenu Thomas,
29
Sithembiso Christopher Velaphi,
29
Daynia Elizabeth Ballot,
29
Trusha Nana,
29
Gary Reubenson,
29
Joy Fredericks,
29
Suvaporn Anugulruengkitt,
30
Anongnart Sirisub,
30
Pimol Wong,
31
Sorasak Lochindarat,
32
Suppawat Boonkasidecha,
32
Kanchana Preedisripipat,
33
Tim R Cressey,
33
Pongsatorn Paopongsawan,
34
Pagakrong Lumbiganon,
34
Dounghatai Pongpanut,
35
Pra-ornsuda Sukrakanchana,
35
Philippa Musoke,
36,37
Linus Olson,
38
Mattias Larsson,
38
Paul T Heath,
1
Michael Sharland
1
To cite: Li G, Bielicki JA,
Ahmed ASMNU, et al.
Arch Dis Child Epub ahead of
print: [please include Day
Month Year]. doi:10.1136/
archdischild-2019-316816
► Additional material is
published online only. To view
please visit the journal online
(http://dx.doi.org/10.1136/
archdischild-2019-316816).
For numbered affiliations see
end of article.
Correspondence to
Professor Michael Sharland,
Institute of Infection and
Immunity, St George’s,
University of London, London
SW17 0RE, UK;
msharlan@sgul.ac.uk
Received 7 January 2019
Revised 31 July 2019
Accepted 6 August 2019
© Author(s) (or their
employer(s)) 2019. Re-use
permitted under CC BY-NC. No
commercial re-use. See rights
and permissions. Published
by BMJ.
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.
INTRODUCTION
Between 2000 and 2015 there was a significant
decline in global neonatal mortality, from 36 to 19
per 1000 live births (5.1–2.7 million cases annu-
ally).
1
This was less pronounced than the reduction
seen in childhood (<5 years) mortality, highlighting
What is already known on this topic?
► The majority of neonatal pathogens in the UK
setting are susceptible to antimicrobials used as
empirical treatment for neonatal sepsis.
► The Delhi Neonatal Infection Study
demonstrated high levels of resistance of
neonatal pathogens to antimicrobials used as
empirical treatment for neonatal sepsis in Delhi.
► The prevalence of extended-spectrum beta-
lactamase (ESBL) Gram-negative infections in
neonates is increasing worldwide.
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