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.
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