Neonatal sepsis: Challenges in data access, harmonisation and analysis to inform empirical antibiotic recommendations in South African neonatal units

Main Article Content

L Bolton
A Bekker
N Govender
C van Schalkwyk
A Whitelaw
A Dramowski

Abstract




Severe bacterial and fungal infections (sepsis) are a leading cause of mortality among neonates in sub-Saharan Africa. In African neonatal units, most sepsis episodes are hospital acquired, and caused by Gram-negative, antimicrobial-resistant pathogens. With rising rates of antimicrobial resistance (AMR) in neonatal sepsis pathogens, there is an increasing probability of inappropriate empirical antibiotic therapy (so called ‘bug-drug’ mismatch or discordant therapy), as confirmation of pathogen identity and antibiotic susceptibility pattern is either not available or delayed. The impact of AMR and discordant empirical treatment on neonatal sepsis outcomes in Africa is largely unknown owing to the lack of the infection surveillance data needed to derive empirical antibiotic treatment recommendations. The Antibiotics for Neonatal Sepsis in Africa (ANSA) study will address this data gap by pooling and harmonising available single-centre research datasets and/or routine laboratory blood culture data to determine which antibiotics should be used for empirical treatment of neonatal sepsis. However, many challenges hamper these datasets, including: variable laboratory methods for pathogen identification and susceptibility testing; difficulty in collating and harmonising data from multiple sites; problems of record linkage in the absence of a single patient identifier; lack of centralised health data capturing systems; and difficulty accessing data due to complex data sharing agreements and custodian permissions. To overcome some of these challenges, minimum guidelines for the collection of neonatal sepsis data need to be defined, to ensure consistency between datasets. Greater collection of, access to and sharing of neonatal sepsis data from institutional, provincial and national laboratories, as well as individual neonatal units, would enable the establishment of a neonatal surveillance network. Development of a sustainably-funded neonatal sepsis surveillance network is a national priority, to ensure effective, evidence-based antimicrobial treatment of hospitalised neonates in South Africa.




Article Details

How to Cite
Neonatal sepsis: Challenges in data access, harmonisation and analysis to inform empirical antibiotic recommendations in South African neonatal units. (2023). Southern African Journal of Public Health, 6(2), 42-44. https://doi.org/10.7196/SAJPH.2023.v6.i2.175
Section
Original Articles

How to Cite

Neonatal sepsis: Challenges in data access, harmonisation and analysis to inform empirical antibiotic recommendations in South African neonatal units. (2023). Southern African Journal of Public Health, 6(2), 42-44. https://doi.org/10.7196/SAJPH.2023.v6.i2.175

References

World Health Organization. Newborn mortality. Newsroom, 28 January 2022. https:// www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality- report-2021 (accessed 26 July 2022).

Sharrow D, Hug L, Lee S, Liu Y, You D. Levels and trends in child mortality, report 2021. New York: United Nations Children’s Fund, 2021. https://www.who.int/publications/m/item/ levels-and-trends-in-child-mortality-report-2021 (accessed 26 July 2022.)

Statistics South Africa. Recorded live births 2020. Pretoria: StatsSA, 2020. https://www. statssa.gov.za/?page_id=1854&PPN=P0305&SCH=73006 (accessed 26 July 2022).

Perin J, Mulick A, Yeung D, . Global, regional, and national causes of under-5 mortality in 2000-19: An updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022;6(2):106-115. https://doi.org/10.1016/S2352- 4642(21)00311-4

Global Antibiotic Research and Development Partnership (GARDP). Transforming the care of babies with sepsis. Geneva: GARDP Foundation, 2022. https://gardp.org/news- resources/gardp-neonatal-sepsis-study-report-2022/ (accessed 26 July 2022).

McGregor JC, Rich SE, Harris AD, . A systematic review of the methods used to assess the association between appropriate antibiotic therapy and mortality in bacteremic patients. Clin Infect Dis 2007;45(3):329-337. https://doi.org/10.1086/519283

Cook A, Hsia Y, Russell N, . Association of empiric antibiotic regimen discordance with 30-day mortality in neonatal and pediatric bloodstream infection – a global retrospective cohort study. Pediatr Infect Dis J 2021;40(2):137-143. https://doi.org/10.1097/INF.0000000000002910

World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report: Early implementation 2020. Geneva: WHO, 2020.

Most read articles by the same author(s)

1 2 3 > >>