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.