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Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network
  1. Grace Li1,
  2. Julia Anna Bielicki1,2,
  3. A S M Nawshad Uddin Ahmed3,
  4. Mohammad Shahidul Islam3,
  5. Eitan Naaman Berezin4,
  6. Clery B Gallacci4,
  7. Ruth Guinsburg5,
  8. Carlos Eduardo da Silva Figueiredo6,
  9. Rosilene Santarone Vieira6,
  10. Andre Ricardo Silva7,
  11. Cristiane Teixeira8,
  12. Paul Turner9,
  13. Ladin Nhan10,
  14. Jaime Orrego11,
  15. Paola Marsela Pérez11,
  16. Lifeng Qi12,
  17. Vassiliki Papaevangelou13,
  18. Pinelope Triantafyllidou14,
  19. Elias Iosifidis15,
  20. Emmanuel Roilides15,
  21. Kosmas Sarafidis15,
  22. Dasaratha Ramaiah Jinka16,
  23. Raghuprakash Reddy Nayakanti16,
  24. Praveen Kumar17,
  25. Vikas Gautam17,
  26. Vinayagam Prakash18,
  27. Arasar Seeralar18,
  28. Srinivas Murki19,
  29. Hemasree Kandraju19,
  30. Sanjeev Singh20,
  31. Anil Kumar20,
  32. Leslie Lewis21,
  33. Jayashree Pukayastha21,
  34. Sushma Nangia22,
  35. Yogesha K N22,
  36. Suman Chaurasia23,
  37. Harish Chellani24,
  38. Stephen Obaro25,
  39. Angela Dramowski26,
  40. Adrie Bekker26,
  41. Andrew Whitelaw27,28,
  42. Reenu Thomas29,
  43. Sithembiso Christopher Velaphi29,
  44. Daynia Elizabeth Ballot29,
  45. Trusha Nana29,
  46. Gary Reubenson29,
  47. Joy Fredericks29,
  48. Suvaporn Anugulruengkitt30,
  49. Anongnart Sirisub30,
  50. Pimol Wong31,
  51. Sorasak Lochindarat32,
  52. Suppawat Boonkasidecha32,
  53. Kanchana Preedisripipat33,
  54. Tim R Cressey33,
  55. Pongsatorn Paopongsawan34,
  56. Pagakrong Lumbiganon34,
  57. Dounghatai Pongpanut35,
  58. Pra-ornsuda Sukrakanchana35,
  59. Philippa Musoke36,37,
  60. Linus Olson38,
  61. Mattias Larsson38,
  62. Paul T Heath1,
  63. Michael Sharland1
  1. 1 Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
  2. 2 Paediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital, Basel, Switzerland
  3. 3 Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
  4. 4 Santa Casa Medical School, São Paulo, Brazil
  5. 5 Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
  6. 6 Instituto Fernandes Figueira, Rio de Janeiro, Brazil
  7. 7 Federal Fluminense University, Rio de Janeiro, Brazil
  8. 8 Prontobaby Children’s Hospital, Rio de Janeiro, Brazil
  9. 9 Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
  10. 10 Angkor Hospital for Children, Siem Reap, Cambodia
  11. 11 Fundación Valle del Lili, Santiago de Cali, Colombia
  12. 12 Shenzhen Children’s Hospital, Shenzhen, China
  13. 13 Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
  14. 14 Attikon University General Hospital, Athens, Greece
  15. 15 School of Health Sciences, Aristotle University, Thessaloniki, Greece
  16. 16 Department of Paediatrics, Rural Development Trust Hospital, Bathalapalli, India
  17. 17 Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  18. 18 Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India
  19. 19 Department of Neonatology, Fernandez Hospital, Hyderabad, India
  20. 20 Amrita Institute of Medical Sciences, Kochi, India
  21. 21 Kasturba Medical College, Manipal, India
  22. 22 Lady Hardinge Medical College, New Delhi, India
  23. 23 All India Institute of Medical Sciences, New Delhi, India
  24. 24 Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
  25. 25 International Foundation Against Infectious Disease in Nigeria, Omaha, Nebraska, USA
  26. 26 Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  27. 27 Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
  28. 28 National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
  29. 29 University of the Witwatersrand, Johannesburg, South Africa
  30. 30 Chulalongkorn University, Bangkok, Thailand
  31. 31 Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  32. 32 Queen Sirikit National Institute of Child Health, Bangkok, Thailand
  33. 33 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  34. 34 Department of Paediatrics, Khon Kaen University, Khon Kaen, Thailand
  35. 35 Phayao Hospital, Phayao, Thailand
  36. 36 Paediatrics and Child Health, Makerere University, Kampala, Kampala, Uganda
  37. 37 Mulago Hospital, Kampala, Uganda
  38. 38 Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden – Vietnam, Hanoi, Vietnam
  1. Correspondence to Professor Michael Sharland, Institute of Infection and Immunity, St George's, University of London, London SW17 0RE, UK; msharlan{at}


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.

  • antimicrobial resistance
  • neonatal sepsis

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  • Contributors MS and PTH conceived this work. JB designed the survey. JB and GL analysed and interpreted the data. GL wrote a first draft. All other authors contributed equally to collection of data. All authors contributed to critical review of drafts and approved the final manuscript.

  • Funding This work was supported by the Global Antibiotic Research and Development Partnership, Geneva.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This was an observational study. No unique patient identifiers were collected, no patient samples were collected and no interventions were performed.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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