An increase in the number of newborns dying from sepsis is linked to antibiotic resistance, say researchers from University College London (UCL).

In a recent study involving more than 3200 newborn babies in 11 different countries, the researchers found that the antibiotics used to treat sepsis are losing their effectiveness, increasing the death rate among newborn babies, particularly in low and middle-income countries.

As a result of the research, the team have developed two clinical tools that can be used in any neonatal intensive care unit around the world to help assess which babies are at the most risk of dying and need urgent treatment.

The findings will inform the World Health Organization (WHO) guidelines on treatment for newborn babies with sepsis and are published in PLOS Medicine.

Sepsis is a complication of an initial infection and can lead to multiple organ failure and death. Globally, it affects up to three million babies a year, and newborns are particularly at risk of severe infection because of their underdeveloped immune systems. Every year, 214,000 newborns, mostly in low- and middle-income countries, die of sepsis that has become resistant to antibiotics.

Between 2019 and 2020, 3,204 babies under two months of age who were hospitalised with sepsis were enrolled in the study. The babies were hospitalised in 19 sites across 11 countries, mainly in Asia and Africa. The researchers looked at clinical signs, supportive care, antibiotic treatment, microbiology and 28-day mortality.

High mortality rates were found when the pathogen causing the sepsis had been identified (culture-positive sepsis). In these cases, one in five infants died across all hospital sites and the researchers found a ‘significant burden’ of antibiotic resistance. Mortality rates varied significantly across hospital sites, with markedly higher rates in low- and middle-income countries (LMICs).

The study highlights worrying trends in antibiotic use. More than 200 different antibiotic combinations were used by hospitals in the study, with frequent switching of antibiotics due to high resistance to treatments. In addition, many clinicians were forced to use antibiotics classified as ‘watch’ antibiotics by WHO. These drugs are only recommended for specific and limited use as they need to be preserved, but were often the only antibiotics available to treat the infection.

Professor Sithembiso Velaphi, head of paediatrics at Chris Hani Baragwanath Academic Hospital in South Africa which was one of the research hospitals, said: ‘The study exposed the glaring reality of antibiotic-resistant infections, especially in hospitals in LMICs, where we are often faced with a shortage of nurses, beds and space.’

He added: ‘The risk of infections is very high, and most infections are resistant to antibiotics. If an antibiotic doesn’t work, the baby often dies. This urgently needs to change. We need antibiotics that will cover all bacterial infections.’

The researchers say that the study has provided a wealth of high-quality data, allowing them to develop two new tools to improve the treatment of newborn babies with sepsis. The first is the NeoSep Severity Score, based on ten clinical signs and symptoms that clinicians can use to identify newborns at risk of dying of sepsis. The second is the NeoSep Recovery Score which provides clinicians with crucial information on whether to escalate treatment.

Dr Wolfgang Stöhr from UCL said: ‘Organisms evolve, drug resistance changes; that is why clinical guidelines for neonatal sepsis need constant adaptation. Updating guidelines relies on recent and good evidence, so this observational study is a significant step towards better treatment.’

This article first appeared in our sister title Nursing in Practice