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

Objective:

Aims to collect paired organisms from blood of babies with sepsis and rectal swabs of mothers. These paired strains will be analyzed for non-susceptibility to antibiotics. These isolates will also be subjected to whole genome sequencing to understand the mechanism of resistance and the genetic relationship between the paired isolates.

Funding source:

Cardiff University (BMGF grant)

Executive Summary:

The investment sought is to establish a network of neonatal centers in five low-middle income countries and to support local clinical epidemiology with state-of-the-art molecular genetics (see figure below). The study will examine risk factors for carriage of multi-drug resistant (MDR) Gram-negative bacteria (GNB) in mothers and subsequent carriage and infections in neonates. The study (BARNARDS) will run for three years and include kick-off workshops and advisory board meetings ensuring inclusiveness and scientific veracity. This is the first study of its type in the world and has implications and ramifications for infection control and mother/infant management. The five clinical centers will collect relevant patient data from both neonate and mother and also microbiological specimens which will be processed locally.

Rectal swabs will be collected from pregnant women priorto delivery, and will be sent to the UK to screen for MDR (specifically ESBL and carbapenemase positive) GNB. Bacterial isolates from neonates from these mothers who develop both early (<7 days) and late onset bacterial sepsis (>7 days) will also be studied, and compared to isolates from the mother. Rectal samples taken from mothers whose infants do not present with infection will be used as a control group. Moreover, we aim to implement an infection control policy supported by an educational campaign to enhance local health awareness in preventing neonatal sepsis.

The molecular platform is a dedicated genomic hub that will provide data on strain type, virulence/pathogenic potential and novel genetic data/mechanisms of resistance. The genomic hub will be run from the UK and visiting fellows from the five centers will travel to the UK to learn about sequencing/molecular biology.
This study will be the first of its kind in the world to blend clinical and molecular epidemiology from LMICs with respect to neonatal Gram-negative infections. The data generated will be used to inform,local, national and international health bodies.

The level of antibiotic resistance in neonatal infections and its impact on mortality in low-middle income countries is unacceptably high. This study will provide the means, support, network and tools to understand the impact of antibiotic resistance on neonatal morbidity and mortality, as well as to identify possible solutions to minimize its impact.

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