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

• Main Authors: Grace Li, Julia Anna Bielicki, A. S.M.Nawshad Uddin Ahmed, Mohammad Shahidul Islam, Eitan Naaman Berezin, Clery B. Gallacci, Ruth Guinsburg, Carlos Eduardo Da Silva Figueiredo, Rosilene Santarone Vieira, Andre Ricardo Silva, Cristiane Teixeira, Paul Turner, Ladin Nhan, Jaime Orrego, Paola Marsela Pérez, Lifeng Qi, Vassiliki Papaevangelou, Pinelope Triantafyllidou, Elias Iosifidis, Emmanuel Roilides, Kosmas Sarafidis, Dasaratha Ramaiah Jinka, Raghuprakash Reddy Nayakanti, Praveen Kumar, Vikas Gautam, Vinayagam Prakash, Arasar Seeralar, Srinivas Murki, Hemasree Kandraju, Sanjeev Singh, Anil Kumar, Leslie Lewis, Jayashree Pukayastha, Sushma Nangia, K. N. Yogesha, Suman Chaurasia, Harish Chellani, Stephen Obaro, Angela Dramowski, Adrie Bekker, Andrew Whitelaw, Reenu Thomas, Sithembiso Christopher Velaphi, Daynia Elizabeth Ballot, Trusha Nana, Gary Reubenson, Joy Fredericks, Suvaporn Anugulruengkitt, Anongnart Sirisub, Pimol Wong, Sorasak Lochindarat, Suppawat Boonkasidecha, Kanchana Preedisripipat, Tim R. Cressey, Pongsatorn Paopongsawan, Pagakrong Lumbiganon, Dounghatai Pongpanut, Pra Ornsuda Sukrakanchana, Philippa Musoke, Linus Olson, Mattias Larsson, Paul T. Heath, Michael Sharland
• Other Authors: Shenzhen Children's Hospital
• Format: Article
• Published: 2020
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/49678
• Institution: Mahidol University

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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.