The level of antibiotic resistance in neonatal infections and its impact on mortality in low- and middle-income countries (LMICs) is unacceptably high. 

The study Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) provides the means, support, network, and tools to understand and reduce the impact of antibiotic resistance on neonatal morbidity and mortality.

The study will be the first of its kind to blend clinical and molecular epidemiology from low- and middle-income countries, generating data that will be used to inform local, national, and international health bodies. The BARNARDS study will focus on monitoring and improving mother and infant wellbeing by exploring the impact of infection control interventions. 

In addition to assessing the burden of antibiotic resistance, we will also determine the prevalence of multi-drug resistant Gram-negative bacteria (MDR_GNB) carried as normal flora that causes neonatal sepsis and identify contributing demographic indices such as population size, overcrowding, access to clean water, sanitation conditions, family size, poverty level and antibiotic usage impact on MDR_GNB.

1 in 5 people who died in 2019 from AMR was a child under 5 years old

LMICs bear the burden of 99% of neonatal mortality worldwide

Building a global dataset

BARNARDS also identified socio-demographic traits such as education, overcrowding, access to clean water, sanitation conditions, living conditions, socioeconomic status and antibiotic usage which may have a role on the development of neonatal sepsis. In addition, hospital environmental samples were collected, including from medical devices and surfaces, to understand if a link between the microbiota of the hospital environment and the late onset of sepsis could be established. Furthermore, BARNARDS produced an extensive dataset of resistance profiles of isolates causing neonatal sepsis and challenged the current paradigm of ampicillin and gentamicin for prophylactic coverage of neonatal sepsis.

The BARNARDS group has established a genomics platform, incorporating a bespoke bioinformatics pipeline which is dedicated to extract key epidemiological information on a large scale. BARNARDS aims to extend this platform by incorporating a metagenomics branch in attempt to track the sepsis-causing isolate within the mother’s microbiome, a novel and unique approach. Our genomics platform can be utilised by our international partners as part of our education and training program. With the aim of sequencing over 2000 isolates, BARNARDS is establishing a comprehensive international database of bacterial isolates causing neonatal sepsis. Although not an initial focal point, Gram-positive pathogens are also being scrutinised due to its relevance in neonatal sepsis in the countries involved. In addition to producing this critical data, BARNARDS group carries a strong educational aspect, supporting the international partners in uniform and excellent microbiology practices and providing study periods in an established molecular / genomics laboratory based in the UK. On publication, data captured during BARNARDS and related findings will be released to the public in the form of publications in high impact scientific peer reviewed journals.

This research has been funded by the Bill and Melinda Gates Foundation, and is now continued by the Ineos Oxford Institute.