Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS)

Introduction

Antimicrobial resistance (AMR) is now recognised as one of the most serious global threats to human health in the 21st century. Evidence of political traction through endorsements of statements by the UK and US governments, WHO and CDC describe a global crisis and an impending catastrophe of moving into a post-antibiotic era. These serious concerns have been catalysed by the rapid increase in Multi-Drug Resistant (MDR) Gram-negative bacteria (GNB), particularly Enterobacteriaceae.

Developing countries bear the burden of 99% of neonatal mortality worldwide (WHO) with infections such as tetanus, pneumonia and sepsis acting as a leading causes of neonatal mortality. Increased antibiotic resistance in bacteria, including MDR pathogens, render infections increasingly difficult to treat, with resistance arising against last resort treatments.

Aims

The BARNARDS project ‘Burden of Antibiotic Resistance in Neonates from Developing Societies’, funded by the Bill and Melinda Gates Foundation, aims to investigate the effects of antibiotic resistance on neonatal morbidity and mortality in low-middle income countries and identify possible solutions to minimise its impacts, particularly in regards to neonatal sepsis. The study will examine risk factors for carriage of MDR GNB in mothers and subsequent carriage and infections in neonates.

A network of neonatal centres within low-middle income countries has been developed through collaboration with leading neonatal scientists/ clinicians from study sites in areas including Nigeria, South Africa, Pakistan, Rwanda and Bangladesh, with new sites being established in Ethiopia and India. Clinical centres at these sites will collect relevant patient data and samples from mothers who have agreed to take part in the study as well as samples from neonates presenting with signs of infection and process microbiological specimens locally. Molecular assessments of samples will also be carried out in the UK using next generation sequencing to screen for MDR (specifically extended spectrum Beta-lactamase and carbapenemase positive) GNB providing information on strain type, pathogenic potential, genetic data and mechanisms of resistance. Comparing neonatal and maternal samples will allow determination of whether the sepsis causing pathogen has originated from the mother’s normal flora during birth.

This study will enable assessment of the burden of antimicrobial resistance on clinical outcomes of neonates and determine common risk factors to identify potential intervention studies and exploration of rapid techniques for diagnosis of sepsis in LMICs.

Summary of aims:

  • Detect antimicrobial resistance patterns in neonatal sepsis in developing countries
  • Discern sources of antimicrobial resistance in neonates
  • Results from this study could lead to interventional studies related to treatment to ensure that sepsis is treated with appropriate antibiotics and Infection Prevention and Control practices.

The BARNARDS group is led by Cardiff University and in affiliation with international research partners in Nigeria, Pakistan, Rwanda, Bangladesh, South Africa, Ethiopia and India.

Project partners

Nigeria

We currently have two sites in Nigeria, including National Hospital Abuja and WUSE General Hospital, Abuja. We have also recently started working with Murtala Muhammad Specialist Hospital, Kano, a hospital in Northern Nigeria with an extremely high delivery rate for which we hope beneficial interventions may arise from the project.

Pakistan

Our site based in Pakistan Institute of Medical Sciences, Islamabad is run in affiliation with Quaid-i-Azam University, Islamabad. This site, currently in a tertiary hospital is due to expand later this year to include community sampling in two local villages, Malpur village and Maira Bhagwal.

Bangladesh

Child Health Research Foundation is partaking in this study in Bangladesh in affiliation with Kumudini Women's Medical college, Dhaka, a secondary care healthcare centre with approximately 550 beds. After a few months of the study, work also began in Chittagong Ma O Shishu Hospital, slightly larger hospital in Chittagong.

Rwanda

We currently work with both Kabgayi Hospital, a secondary care hospital with approximately 416 beds in the Muhango district and Centre Hospitalier Universitaire de Kigali (CHUK), a tertiary care hospital of similar size in Kigali, in affiliation with the University of Rwanda.

South Africa

Our site in South Africa is based at Tygerberg Hospital, Cape Town. This is a tertiary hospital with approximately 1384 beds attached to a medical faculty affiliated to Stellenbosch University.

Our project coordinator for South Africa, Professor Mehtar is also our coordinator for infection prevention and control in this study with expertise in this area as the chair person for Infection Control Africa Network.

Recent supplementary funding has also allowed us to start working more closely with sites in Ethiopia and India, sites dues to start partaking in this study later this year (2016).

Ethiopia

Our site getting ready to partake in the project in Ethiopia is based at St Paul's Hospital Millenium Medical College, Addis Ababa, in affiliation with Children's Hospital Boston.

India

We will be working in Kolkata with the National Institute of Cholera and Enteric Diseases (NICED) alongside the Institute of Post Graduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial Hospital (SSKM).

Lead researcher

Tim Walsh

Professor Timothy Walsh

Professor

Email:
walshtr@cardiff.ac.uk
Telephone:
+44 (0)29 2074 4725

Academic staff

Maria Carvalho

Dr Maria Mendes De Carvalho

Co-lead/Manager Scientist

Email:
carvalhom@cardiff.ac.uk

Postgraduate students

Associated staff

Rebecca Milton

Project Manager

Email:
miltonrl1@cardiff.ac.uk
Telephone:
+44 (0)29 2074 4725

Edward Portal

Email:
portale@cardiff.ac.uk


Partners

This research was made possible through our close partnership with and support from international partners and funding from the Bill and Melinda Gates Foundation.