Antimicrobial resistance in India threatens the survival of newborns

September 21, 2016

Multicenter study of neonatal sepsis and resistance in India underscores the need for greater attention and prevention strategies

In a large multi-center study of neonatal sepsis in tertiary care hospitals in India, sepsis incidence and mortality was high and antimicrobial resistance increased the case fatality rates. Overall, nearly one-quarter of the neonatal deaths were from sepsis. The results, published in The Lancet, indicate the need to understand the pathogenesis of sepsis in newborns and infants, as well as the need to implement proven infection control interventions to prevent the illness in low-income and middle-income countries.

CDDEP Director Ramanan Laxminarayan, in a Lancet comment, highlights the importance of sepsis prevention in newborns, as births in India and other low- and middle-income countries are increasingly institutionalized. Estimates indicate that 56,524 newborns die each year in India from sepsis due to infections caused by bacteria resistant to first-line antibiotics.

Neonatal sepsis or meningitis accounted for 421,000 deaths in 2013, roughly 16 percent of neonatal deaths worldwide. Facility-based births could help reduce the risk of sepsis; however, the risk of acquiring an antibiotic resistant infection is dramatically increased due to poor infection control.

The Delhi Neonatal Infection Study (DeNIS), examined 88,636 newborns over nearly three years in three large hospitals in Delhi, India—one of the largest studies to date of neonatal sepsis and antibiotic resistance in the Indian subcontinent. Before this study, our understanding of the impact of antimicrobial resistance was based mostly in small single-center studies. DeNIS highlights the serious risk associated with neonatal sepsis and resistance in health-care facilities and the importance of preventive strategies to reduce the risks and burden of neonatal infections.

According to Laxminarayan, “Recognizing that births in India are becoming increasingly institutionalized, the quality of care and infection control in healthcare institutions must be a priority and must receive greater attention and resources.”

The DeNIS study in The Lancet is available here:

The comment in The Lancet is available here:


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The Center for Disease Dynamics, Economics & Policy (CDDEP) produces independent, multidisciplinary research to advance the health and wellbeing of human populations around the world.  CDDEP projects are global in scope, spanning Africa, Asia, and North America and include scientific studies and policy engagement.  The CDDEP team is experienced in addressing country-specific and regional issues, as well as the local and global aspects of global challenges, such as antibiotic resistance and pandemic influenza. CDDEP research is notable for innovative approaches to design and analysis, which are shared widely through publications, presentations and web-based programs.  CDDEP has offices in Washington, D.C. and New Delhi and relies on a distinguished team of scientists, public health experts and economists.

Commentary authors: Ramanan Laxminarayan, Zulfiqar A. Bhutta


21 Sep 2016