Neonatal sepsis and antimicrobial resistance in Africa

Mortality rates in children younger than 5 years have reduced by half globally since 1990, but neonatal mortality rates remain high and far from the Sustainable Development Goal target of less than 12 deaths per 1000 livebirths by 2030. 1 Sharrow D Hug L You D et al. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet Glob Health. 2022; 10: e195-e206 Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar Sepsis is a leading cause of death in the first 28 days of life, particularly in sub-Saharan Africa. Bacterial sepsis is dominated by Gram-negative pathogens with substantial antimicrobial resistance, contributing to this region having the highest death rates attributable to antimicrobial resistance globally. 2 Murray CJL Ikuta KS Sharara F et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022; 399: 629-655 Summary Full Text Full Text PDF PubMed Scopus (2495) Google Scholar WHO's antibiotic treatment guidelines have not kept pace with the exponential rise of antimicrobial resistance in sub-Saharan Africa, potentially exacerbating neonatal sepsis deaths. We, as representatives of the African Neonatal Association, call for urgent action and innovation (panel). PanelApproaches and stakeholders needed to address neonatal sepsis and antimicrobial resistance in AfricaTreatment guidelines for antimicrobial stewardship •Pharmaceutical companies develop neonatal and paediatric antibiotic formulations •Researchers conduct multi-country neonatal pharmacokinetic studies to provide dosing and administration guidance and to systematically collect data on antimicrobial recycling for evidence of when this can be safely practised •Local hospitals, ministries of health, and WHO update local and regional guidelines with targeted regimens (eg, for inborn vs outborn neonates, timing of sepsis onset, routine vs outbreak settings); replace first-line with second-line antimicrobials as empirical treatment in areas with high community antimicrobial resistance rates; include older antimicrobials with restored favourable susceptibility profiles (eg, chloramphenicol), with guidance on safety monitoring •Ministries of health and WHO advocate for equitable access to new antibiotics in African countries •Local hospitals and health-care training institutions provide education and in-service training on antimicrobial stewardship Infection diagnosis and surveillance •WHO, ministries of health, local hospitals, and academic institutions establish centralised hubs as opposed to satellite sites for regional reference laboratory networks •WHO and ministries of health develop and implement standardised surveillance methods for low-resource settings Infection prevention and control •WHO develops guidelines for safe processing and reuse of single-use items •Hospitals promote pathogen reduction and decolonisation—eg, alcohol rub for routine hand hygiene, chlorhexidine bathing, skin-to-skin care, and exclusive breastfeeding Treatment guidelines for antimicrobial stewardship •Pharmaceutical companies develop neonatal and paediatric antibiotic formulations •Researchers conduct multi-country neonatal pharmacokinetic studies to provide dosing and administration guidance and to systematically collect data on antimicrobial recycling for evidence of when this can be safely practised •Local hospitals, ministries of health, and WHO update local and regional guidelines with targeted regimens (eg, for inborn vs outborn neonates, timing of sepsis onset, routine vs outbreak settings); replace first-line with second-line antimicrobials as empirical treatment in areas with high community antimicrobial resistance rates; include older antimicrobials with restored favourable susceptibility profiles (eg, chloramphenicol), with guidance on safety monitoring •Ministries of health and WHO advocate for equitable access to new antibiotics in African countries •Local hospitals and health-care training institutions provide education and in-service training on antimicrobial stewardship Infection diagnosis and surveillance •WHO, ministries of health, local hospitals, and academic institutions establish centralised hubs as opposed to satellite sites for regional reference laboratory networks •WHO and ministries of health develop and implement standardised surveillance methods for low-resource settings Infection prevention and control •WHO develops guidelines for safe processing and reuse of single-use items •Hospitals promote pathogen reduction and decolonisation—eg, alcohol rub for routine hand hygiene, chlorhexidine bathing, skin-to-skin care, and exclusive breastfeeding