Bacterial neonatal sepsis and antibiotic resistance in low-income countries

Abstract

Tackling neonatal sepsis and antibiotic resistance is extremely challenging in low-income countries where neonatal mortality is high and antibiotic resistance is growing.1Liu L Oza S Hogan D et al.Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis.Lancet. 2015; 385: 430-440Summary Full Text Full Text PDF PubMed Scopus (1996) Google Scholar, 2WHOAntimicrobial resistance: global report on surveillance 2014. World Health Organization, Geneva2014Google Scholar Essential data on the burden of severe bacterial infections in neonates and bacterial causes are scarce in low-income countries, and the role of antibiotic resistance remains unclear. Relevant surveillance systems are needed to improve understanding of these issues and to guide local, regional, and international public health policies. Importantly, surveillance of infections should include rigorous population-level measures within the community because a large proportion of people in low-income countries might not consult in-health facilities. Additionally, effective surveillance must account for the timely diagnosis of severe bacterial infections, which can be challenging in low-income country settings and particularly for neonates as infections can quickly become fatal. Along with scarce access to health facilities, early detection of severe bacterial infections is further delayed by inadequate family knowledge of clinical signs suggestive of neonatal infections and training of health-care workers. Lastly, accurate bacterial diagnosis and resistance profiles need health-care workers to be trained to take samples from infants and need skilled staff with access to appropriate laboratory equipment, which are generally only available in hospitals in low-income countries.3Huynh BT Padget M Garin B et al.Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?.BMC Infect Dis. 2015; 15: 127Crossref PubMed Scopus (48) Google Scholar Additionally, optimisation of treatment against severe bacterial infections should be a priority in low-income countries to reduce mortality and manage antibiotic resistance. Unfortunately, it is not currently possible to update local antibiotic guidelines and change patient antibiotic regimens in many countries because there is no diagnostic capacity (eg, resistance profiles). Development of innovative point-of-care instruments for use in low-income countries might provide a solution. New antibiotics would help to restrict the emergence of resistance and to treat severe bacterial infections, but their use needs to be monitored to avoid the development of new resistance mechanisms.4Köser CU Ellington MJ Peacock SJ Whole-genome sequencing to control antimicrobial resistance.Trends Genet. 2014; 30: 401-407Summary Full Text Full Text PDF PubMed Scopus (168) Google Scholar Lastly, a better understanding of the driving forces of bacterial sepsis and transmission, particularly the role of mother-to-child transmission, is needed to help fight neonatal sepsis and antibiotic resistance.5Chan GJ Lee AC Baqui AH Tan J Black RE Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis.PLoS Med. 2013; 10: e1001502Crossref PubMed Scopus (138) Google Scholar Insights are needed into the factors that affect pathogenicity and transmissibility of multidrug-resistant bacteria and mobile genetic elements, especially about extended-spectrum β-lactamases or carbapenemase producing Enterobacteriaceae that cause a substantial proportion of neonatal sepsis. Currently, bacterial infections and antibiotic resistance in children—especially neonates—in low-income countries is a neglected, international, public health problem. To tackle and decrease neonatal mortality from these two major threats requires addressing the challenges described in addition to increasing awareness of national policy makers, establishing programmes to combat bacterial neonatal sepsis and resistance in health-care systems, and stimulating necessary research programmes. All authors report grants from TOTAL Corporate Foundation, MSDAVENIR, Monaco Department of International Cooperation, and Institut Pasteur. We declare no competing interests. Download .pdf (.23 MB) Help with pdf files Supplementary appendix Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysisOur projection results provide concrete examples of how the distribution of child causes of deaths could look in 15–20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. Full-Text PDF