BARNARDS

Overview

BARNARDS is a multi-country research programme led by the Ineos Oxford Institute for Antimicrobial Research (IOI) to understand the burden and impact of antimicrobial resistance (AMR) in neonatal sepsis across low- and middle-income countries (LMICs).

Neonatal sepsis remains one of the leading causes of newborn mortality globally. Effective treatment depends on timely diagnosis and appropriate antibiotic therapy. However, rising levels of antimicrobial resistance threaten the success of standard treatments, particularly in resource-limited settings where microbiology facilities and surveillance systems are often limited.

BARNARDS generates high-quality clinical, microbiological, genomic, and health-economic data to inform better treatment guidelines, strengthen antimicrobial stewardship, and support infection prevention and control.

 

Why BARNARDS Matters

• Each year, hundreds of thousands of newborns die from sepsis.
• Many infections are caused by multidrug-resistant (MDR) or extensively drug-resistant (XDR) bacteria.
• Empirical antibiotic therapy is often used without access to reliable microbiology data.
• The true burden of AMR in neonatal sepsis in LMICs remains under-documented.

BARNARDS addresses these gaps by producing robust, actionable data to guide policy and clinical practice.

 

What the Study Does

BARNARDS is an observational, prospective cohort study enrolling neonates across multiple hospitals in Africa and Asia. The study:

• Determines the incidence and outcomes of neonatal sepsis
• Identifies the most common bacterial and fungal pathogens
• Measures rates of antimicrobial resistance, including MDR and XDR organisms
• Analyses antibiotic prescribing patterns and appropriateness
• Evaluates access, affordability, and availability of antibiotics
• Conducts hospital environmental surveillance to assess transmission dynamics
• Performs whole genome sequencing (WGS) to understand resistance mechanisms and outbreak patterns

The study includes both inborn neonates and babies admitted with suspected sepsis, with follow-up to assess clinical outcomes.

 

A Unique and Comprehensive Dataset

BARNARDS integrates:

• Clinical and socio-demographic data
• Detailed antibiotic dosing and treatment changes
• Microbiology and susceptibility testing
• Genomic analysis of pathogens
• Infection prevention and control (IPC) assessments
• Health-economic and access-to-care data

This comprehensive approach allows researchers to link resistance profiles with treatment decisions and patient outcomes, providing real-world evidence on the impact of AMR in neonatal care.

 

Strengthening Capacity in LMICs

Beyond research, BARNARDS strengthens local capacity by:

• Supporting blood culture and microbiology services
• Standardising diagnostic procedures
• Providing training for laboratory and clinical staff
• Enhancing antimicrobial stewardship practices
• Generating locally relevant resistance data to guide empirical therapy

The programme promotes sustainable improvements in neonatal infection management and AMR surveillance.

 

Impact

BARNARDS findings are informing:

• National and international treatment guidelines
• WHO engagement on empirical antibiotic recommendations
• Hospital-level antimicrobial stewardship policies
• Infection prevention strategies
• Future intervention studies

By delivering high-quality data from resource-limited settings, BARNARDS is contributing to global efforts to reduce neonatal mortality and combat antimicrobial resistance.