Prevention of Infection in Indian Neonates

描述(申请人提供)：印度，世界上最大的国家之一 人口，继续与极高的婴儿和新生儿作斗争 死亡率。败血症现在占社区出生人口死亡的50% (医院出生的婴儿死亡率为20%)。与此息息相关 是一个新兴的抗菌素耐药性问题，它越来越多地 限制医疗服务提供者的治疗选择。要处理 针对这些关键问题，调查员建议成立一个研究组 对印度妇幼保健的研究，基于强大的现有合作 儿科和流行病学系的调查人员和 巴尔的摩的UMSM和新德里的AIIMS的预防医学，以及 印度奥里萨邦的医院和卫生部。这个 申请者最初将开发基础设施来监控发生 社区和医院出生的婴儿的新生儿败血症。这将包括： 1)所有住院儿童和被带到医院的儿童的身份证明 医院，被诊断为败血症；2)从这些人那里获得血培养 儿童；3)从血培养中分离出的所有细菌菌株的筛选 4)收集基本人口学、危险因素、 和每个病例的治疗数据；以及5)开发基于计算机的系统 和用于数据管理的网络。在奥里萨邦的村庄，申请者 将建立一个村级监控系统，以识别妇女在他们的 怀孕，监测妊娠结局，并建立转诊机制 所有潜在的败血症婴儿送到参与的诊所或医院 评估，包括血液培养的收集。后续研究将 确定引起败血症的细菌分离株的潜在来源。为此， 申请者将筛查婴儿的皮肤、鼻孔和粪便培养(和 皮肤、鼻孔和阴道培养)，并寻求匹配血液 用分子流行病学方法检测具有这些定植分离物的分离物 技巧。在赠款期间的最后几年，根据这些数据 收集系统到位后，申请者将启动一系列 干预措施，包括实施以医院和社区为基础的 系统的首选抗菌素，使用益生菌来降低感染风险 新生儿败血症，并在医院推行酒精洗手产品 以及以社区为基础的医疗保健环境，以最大限度地减少病原体传播。

DESCRIPTION (Provided by applicant): India, with one of the world's largest populations, continues to struggle with extremely high infant and neonatal mortality rates. Sepsis now accounts for 50% of deaths among community-born (and 20% of mortality among hospital-born) infants. Closely linked with this is a burgeoning problem with antimicrobial resistance, which is increasingly restricting the therapeutic options for medical care providers. To deal with these critical issues, the investigators propose to establish a Research Unit for the study of MCH in India, based on strong, existing collaborations between investigators in the Department of Pediatrics and Epidemiology and Preventive Medicine at the UMSM, Baltimore, and the AIIMS, New Delhi, and hospitals and the Ministry of Health in the state of Orissa, India. The applicant will initially develop an infrastructure to monitor occurrence of neonatal sepsis in community- and hospital-born infants. This will include: 1) identification of all hospitalized children, and children brought to hospital, with the diagnosis of sepsis; 2) obtaining blood cultures from these children; 3) screening of all bacterial strains isolated from blood cultures for antimicrobial resistance; 4) collecting basic demographic, risk factor, and treatment data on each case; and 5) development of a computer-based system and network for data management. In villages of Orissa State, the applicants will set up a village-level surveillance system to identify women during their pregnancy, monitor pregnancy outcomes, and establish a mechanism for referral of all potentially septic infants to participating clinics or hospitals for evaluation, including collection of blood cultures. Subsequent studies will identify potential sources of bacterial isolates causing sepsis. To this end, the applicants will screen skin, nares, and stool cultures from infants (and skin, nares, and vaginal cultures from their mothers), and seek to match blood isolates with these colonizing isolates, using molecular epidemiologic techniques. In the latter years of the grant period, and with these data collection systems in place, the applicants will initiate a series of interventions, including implementation of a hospital- and community-based system of "preferred" antimicrobials, use of probiotics to reduce the risk of neonatal sepsis, and implement alcohol-based hand-washing products in hospital and community-based healthcare settings to minimize pathogen transmission.