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Antimicrobial resistance: think globally but act locally
  1. Trevor Duke1,2,
  2. Nicole X Wong3
  1. 1Intensive Care Unit and Department of Paediatrics, Royal Children's Hospital, University of Melbourne, MCRI, Parkville, Victoria, Australia
  2. 2School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
  3. 3General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Professor Trevor Duke, Intensive Care Unit and University of Melbourne Department of Paediatrics, Royal Childrens Hospital, Parkville, VIC 3052, Australia; trevor.duke{at}rch.org.au

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The problems of antimicrobial resistance (AMR) are global and enormous. Like other global, enormous problems it is often difficult to know where to start—and it is easy to doubt that individual efforts will have meaningful impact. With all such problems, accurate data are important but are hard to come by. Li et al1 from 39 hospitals in 12 countries provide revealing insights into the extent of AMR and antibiotic prescribing practices in neonatal units through a Neonatal AMR network (NeoAMR) of tertiary units in Asia, Africa and South America. The study proves that global-scale AMR surveillance networks can be established and yield useful information for clinicians and policy makers.

In this study, AMR in neonatal infections (both early and late onset) was widespread. More than 50% of enteric Gram-negative bacilli isolated from blood cultures were resistant to third-generation cephalosporins in 8 of the 10 countries where hospitals reported this. Further, carbapenem resistance was a significant problem in Gram-negative isolates from at least half the countries. Resistance among Gram-positive bacteria was less common, but vancomycin-resistant enterococci were emerging as a problem in two countries (Nigeria and India). There are limitations in this early report from the NeoAMR in their method and in the data reported. The results do not tell us about population-based prevalence of AMR in newborn sepsis, nor about AMR in health facilities outside tertiary hospitals. No attempt is made to distinguish community-acquired from hospital-acquired infections, and aminoglycoside resistance rates are not reported.

AMR drives poor prescribing, and poor prescribing drives AMR: it is a vicious cycle. The study is most revealing in the reported first-line antibiotic therapies for neonatal infections. Only 16 of 39 (41%) hospitals used antibiotic therapy for early-onset neonatal sepsis (EOS) that is consistent with that recommended by the WHO: ampicillin (or benzylpenicillin) plus …

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