DeNIS collaboration: setting the future research agenda
Authors: Shrey Mathur, Grace Li, Laura Folgori, Mike Sharland, Paul T Heath
Journal: The Lancet Global Health (2016)

We salute the huge efforts of the DeNIS collaboration (October, 2016).1Investigators of the Delhi Neonatal Infection Study (DeNIS) collaborationCharacterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study.Lancet Glob Health. 2016; 4: e752-e760Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar Their study not only comprehensively sets the scene for neonatal sepsis and antimicrobial resistance in a low-income and middle-income setting but also, by highlighting gaps in our understanding of neonatal sepsis and antimicrobial resistance, sets the future research agenda. The absence of a globally accepted single standard definition of multidrug resistance is a key issue.2Sievert DM Ricks P Edwards JR et al.Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010.Infect Control Hosp Epidemiol. 2013; 34: 1-14Crossref PubMed Scopus (1191) Google Scholar, 3Magiorakos AP Srinivasan A Carey RB et al.Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect. 2012; 18: 268-281Summary Full Text Full Text PDF PubMed Scopus (6983) Google Scholar Difficulties in showing a clear relationship between antimicrobial resistance and outcomes might reflect the absence of clinical relevance of currently used definitions. Standardised definitions for multidrug resistance, which account for infection type, age, and key risk factors, are now needed. The high rates of Acinetobacter and coagulase-negative staphylococcal infections among the pathogens causing early-onset sepsis are striking, but additionally they emphasise the absence of validated definitions for clinical sepsis.4Fitchett EJ Seale AC Vergnano S et al.Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI): an extension of the STROBE statement for neonatal infection research.Lancet Infec Dis. 2016; 16: e202-e213Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar Knowledge of the clinical features and outcomes associated with such cases and their correlation with those of more established pathogens, as well as non-infected control babies, might help our understanding of their relevance and aid in validating new definitions. The study1Investigators of the Delhi Neonatal Infection Study (DeNIS) collaborationCharacterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study.Lancet Glob Health. 2016; 4: e752-e760Summary Full Text Full Text PDF PubMed Scopus (191) Google Scholar reported high rates of antimicrobial resistance and also reminds us of the paucity of new drugs to treat such infections, especially in neonates, as well as the paucity of data on antimicrobial pharmacokinetics in this population. Observational and interventional multicentre studies are needed to establish the safety and efficacy of new regimens and antibiotics (targeted at antimicrobial-resistant pathogens) compared with existing combinations, together with new strategies for using them wisely.5Bielicki JA Sharland M Johnson AP et al.Selecting appropriate empirical antibiotic regimens for paediatric bloodstream infections: application of a Bayesian decision model to local and pooled antimicrobial resistance surveillance data.J Antimicrob Chemother. 2015; 30: dkv397Google Scholar Further study in low-income and middle-income countries is required and the DeNIS collaboration is a landmark step in this direction. We declare no competing interests. Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort studyThe high incidence of sepsis and alarming degree of antimicrobial resistance among pathogens in neonates born in tertiary hospitals underscore the need to understand the pathogenesis of early-onset sepsis and to devise measures to prevent it in low-income and middle-income countries. Full-Text PDF Open Access