. 2021 Sep 27;5(1):e001156. doi: 10.1136/bmjpo-2021-001156

Table 5.

Antimicrobial resistance and antimicrobial stewardship in neonatal and paediatric care

Key messages	Why is it important?	Current challenges	Recommendations
Patients, and especially newborns and children, are harmed by and even die because of antimicrobial resistance (AMR) in MSF projects. The problem is escalating in front of us like an invisible tsunami, with limited visibility on its burden and consequences. It is critical for MSF to systematically implement the available tools to reduce AMR, especially where microbiology is not available: infection prevention and control (IPC) and antibiotic stewardship	AMR is a reality in humanitarian settings and newborn and children are particularly exposed. Multidrug-resistant bacterial sepsis particularly affects the most fragile patients, as shown by the increase in the reports of outbreaks in neonatal units in low-resource settings. IPC and antibiotic stewardship are crucial and effective strategies against AMR, particularly in contexts where microbiology is unavailable.	There is lack of awareness on the increasing paediatric and neonatal morbidity and mortality because of AMR in humanitarian settings. There is a false perception that AMR does not affect low-resource settings and limited available data to accurately define the extent of the problem. Misconception that without microbiology, it is not possible to tackle AMR. There are gaps on access to microbiological tools.	Field Strengthen awareness and training on IPC interventions, and scale up use of IPC quality improvement tools. Create multidisciplinary AMR project committee including all the relevant health workers (nurses, doctors, pharmacists, IPC focal points, cleaners), and identify focal points and champions. Scale up use of audits of antimicrobial use. Operations Integrate AMR and antibiotic stewardship as part of quality improvement initiatives. Formalise AMR and IPC focal point roles in job descriptions. Increase access to microbiological tools available to the field, including exploring partnerships with national and regional laboratories. Research/Headquarters Adapt IPC assessment tools to address specific challenges in neonatal and paediatric care. Update guidelines in accordance with evidence on AMR in different infection syndromes. Explore alternative metrics/indicators for antibiotic use in children to guide antibiotic stewardship.

Key messages

Why is it important?

Current challenges

Recommendations

Patients, and especially newborns and children, are harmed by and even die because of antimicrobial resistance (AMR) in MSF projects. The problem is escalating in front of us like an invisible tsunami, with limited visibility on its burden and consequences.

It is critical for MSF to systematically implement the available tools to reduce AMR, especially where microbiology is not available: infection prevention and control (IPC) and antibiotic stewardship

AMR is a reality in humanitarian settings and newborn and children are particularly exposed.

Multidrug-resistant bacterial sepsis particularly affects the most fragile patients, as shown by the increase in the reports of outbreaks in neonatal units in low-resource settings.

IPC and antibiotic stewardship are crucial and effective strategies against AMR, particularly in contexts where microbiology is unavailable.

There is lack of awareness on the increasing paediatric and neonatal morbidity and mortality because of AMR in humanitarian settings.
There is a false perception that AMR does not affect low-resource settings and limited available data to accurately define the extent of the problem.
Misconception that without microbiology, it is not possible to tackle AMR.
There are gaps on access to microbiological tools.

Field

Strengthen awareness and training on IPC interventions, and scale up use of IPC quality improvement tools.
Create multidisciplinary AMR project committee including all the relevant health workers (nurses, doctors, pharmacists, IPC focal points, cleaners), and identify focal points and champions.
Scale up use of audits of antimicrobial use.

Operations

Integrate AMR and antibiotic stewardship as part of quality improvement initiatives.
Formalise AMR and IPC focal point roles in job descriptions.
Increase access to microbiological tools available to the field, including exploring partnerships with national and regional laboratories.

Research/Headquarters

Adapt IPC assessment tools to address specific challenges in neonatal and paediatric care.
Update guidelines in accordance with evidence on AMR in different infection syndromes.
Explore alternative metrics/indicators for antibiotic use in children to guide antibiotic stewardship.

AMR, Antimirobial resistance; IPC, Infection prevention and control; MSF, Médecins Sans Frontières.