Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.
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Li Grace, Bielicki Julia Anna, Ahmed A S M Nawshad Uddin, Islam Mohammad Shahidul, Berezin Eitan Naaman, Gallacci Clery B, Guinsburg Ruth, da Silva Figueiredo Carlos Eduardo, Santarone Vieira Rosilene, Silva Andre Ricardo, Teixeira Cristiane, Turner Paul, Nhan Ladin, Orrego Jaime, Pérez Paola Marsela, Qi Lifeng, Papaevangelou Vassiliki, Triantafyllidou Pinelope, Iosifidis Elias, Roilides Emmanuel, Sarafidis Kosmas, Jinka Dasaratha Ramaiah, Nayakanti Raghuprakash Reddy, Kumar Praveen, Gautam Vikas, Prakash Vinayagam, Seeralar Arasar, Murki Srinivas, Kandraju Hemasree, Singh Sanjeev, Kumar Anil, Lewis Leslie, Pukayastha Jayashree, Nangia Sushma, K N Yogesha, Chaurasia Suman, Chellani Harish, Obaro Stephen, Dramowski Angela, Bekker Adrie, Whitelaw Andrew, Thomas Reenu, Velaphi Sithembiso Christopher, Ballot Daynia Elizabeth, Nana Trusha, Reubenson Gary, Fredericks Joy, Anugulruengkitt Suvaporn, Sirisub Anongnart, Wong Pimol, Lochindarat Sorasak, Boonkasidecha Suppawat, Preedisripipat Kanchana, Cressey Tim R, Paopongsawan Pongsatorn, Lumbiganon Pagakrong, Pongpanut Dounghatai, Sukrakanchana Pra-Ornsuda, Musoke Philippa, Olson Linus, Larsson Mattias, Heath Paul T, Sharland Michael
Аннотация
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.