Introducing BARNARDS!

We are extremely pleased to announce the launch of the BARNARDS website!

The BARNARDS project is an international collaborative of research into the Burden of Antibiotic Resistance in Neonates in Developing Societies, with researchers and medical staff across the UK, Africa and South Asia working together to combat neonatal mortality and morbidity in low-middle income countries (LMICs) as the result of sepsis causing antibiotic resistant bacteria.

Antimicrobial resistance (AMR) is fast becoming one of the largest and fastest growing threats to human health. With increasing globalisation, bacteria can rapidly develop resistance mechanisms that render front-line and last-resort antibiotics ineffective. Multi-drug resistance (MDR) is particularly problematic with MDR bacteria being tolerant to a range of antimicrobial treatments.

BARNARDS is particularly focused on multi-drug resistant Gram-negative bacteria (MDR GNB) carrying the resistance genes blaCTX-M, blaOXA-48-like, blaNDM and blaKPC, indicative of the presence of extended-spectrum β-lactamases and carbapenemases producing bacteria. These enzymes confer resistance to β-lactam antibiotics, the most widely used drugs to combat clinical and community infections caused by GNB. Particularly, the presence of carbapenemases is greatly concerning as they render the host bacteria resistant to carbapenems, which are last-resort antibiotics.

With developing countries accounting for 99% of the worlds neonatal mortality from sepsis, BARNARDS aims to:

• Provide the means, support, network and tools to understand the impact of antibiotic resistance on neonatal morbidity and mortality and identify possible solutions to minimize its impact.

• Blend clinical and molecular epidemiology from LMICs with respect to neonatal Gram-negative infections using a range of microbiological and molecular/genomics techniques

• Monitor and improve mother and infant wellbeing by exploring the impact of infection control interventions.

• Determine the prevalence of multi-drug resistant Gram-negative bacteria (MDR_GNB) carried as the mother’s normal micriobiota that causes neonatal sepsis and identify any contributing risk factors for sepsis within sociodemographic traits, living and sanitary conditions and the clinical histories and outcomes for the mothers and their babies.

• To create a genomics platform amongst partner countries, housing over 4000 bacterial isolates, establishing a comprehensive international neonatal Gram-negative sepsis database – the first of its type worldwide.

• To support participating clinical centers in uniform and excellent microbiology, molecular/genomic practices.

• To use the data generated to inform local, national and international health bodies.

From all in the BARNARDS group, we hope that this website serves as a portal where everyone can follow the work done in this project, the stories shared by the BARNARDS team members and where all can learn about the global problem of AMR.

A story from Kano, Nigeria

A touching story from our Nigerian BARNARDS Project Coordinator that encapsulates the heart of BARNARDS, aiming to reduce neonatal mortality in developing societies as a result of sepsis caused by antimicrobial resistant bacteria.

“When we were at the neonatal ward, I noticed a young mother staring at her baby silently while her baby lay still and motionless. She did not utter a word. The ward was so busy and all the staff were preoccupied. I called the attention of the doctors, who then began to resuscitate an already dead baby on the makeshift resuscitare (a cold brown table). After a couple of minutes the baby was wrapped up in a cloth and the nurse called out for the mum. The baby’s grandma came up and carried the baby in her arms silently. I watched them leave without uttering a sound, without shedding a tear, it was almost like nothing happened but I could see their silent pain. The doctors swiftly moved on to the next patient…”

-Zahra Modibbo, June 2016

Presentation of results from BARNARDS 2015-2018- Rwanda

Presentation of results from BARNARDS 2015-2018- Rwanda


BARNARDS participant recruitment has now long been closed and the team have been working tirelessly to coordinate analysis of the multitude of complex data it has generated across epidemiology, genomics and microbiology; ascertaining new understanding of antimicrobial resistance and neonatal sepsis across seven countries and twelve different sites. We will be sharing the BARNARDS data and findings so far at some of our participating sites. These will be open events and all are welcome, researchers, health practitioners, academics, members of the public, BARNARDS mothers and babies!
Find the poster for the upcoming event here

We hope that as many as possible can join us. Ensure to follow the BARNARDS blog to receive notifications of all upcoming events.

Please print and display to raise awareness of the event at location!!

Presentation of results from BARNARDS 2015-2018- Pakistan

 Presentation of results from BARNARDS 2015-2018- Pakistan


BARNARDS participant recruitment has now long been closed and the team have been working tirelessly to coordinate analysis of the multitude of complex data it has generated across epidemiology, genomics and microbiology; ascertaining new understanding of antimicrobial resistance and neonatal sepsis across seven countries and twelve different sites. We will be sharing the BARNARDS data and findings so far at some of our participating sites. These will be open events and all are welcome, researchers, health practitioners, academics, members of the public, BARNARDS mothers and babies!
Find the poster for the upcoming event here

We hope that as many as possible can join us. Ensure to follow the BARNARDS blog to receive notifications of all upcoming events.

Please print and display to raise awareness of the event at location!!


BARNARDS at ECCMID 2019, Amsterdam

We are excited to announce BARNARDS was successful in having a number of abstracts for posters and presentations accepted for the 29th European Congress of Clinical Microbiology & Infectious Diseases, with our lead scientist Maria De Carvalho winning the ISF/ESCMID Sepsis award in recognition of an exceptional abstract.

The European Congress of Clinical Microbiology and Infectious Diseases is the annual meeting of ESCMID, the European Society of Clinical Microbiology and Infectious Diseases.

Attendance and presentation at this event allowed BARNARDS team members to present on BARNARDS with some first early findings. We had the opportunity of sharing this information with friends, peers, clinicians and colleagues, contributing to the knowledge base of neonatal sepsis and antimicrobial resistance in low-middle income countries to reduce neonatal mortality.

The list of BARNARDS posters and presentations at ECCMID are listed as follows:

    • 2019 ISF/ESCMID Sepsis award winner – Maria De Carvalho “Insights into the normal microbiota of mothers, infants and clinical environment and genomes of bacterial isolates causing sepsis in infants from low- and middle-income countries”

    Click the presentation image below to access the presentation abstract
    Maria presentation 1

    • Kirsty Sands “Whole genome characterisation of bacterial isolates causing sepsis in infants in low-middle income countries”

    Click the presentation image below to access the presentation abstract
    Kirsty presentation 1

    • Rebecca Milton “Incidence of neonatal sepsis from hospitals in South Asia and Africa: Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS)”

    Click the presentation image below to access the presentation abstract

    Becca 1

    • Rebecca Milton “Risk Factors of neonatal sepsis from hospitals in South Asia and Africa: Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS)”

    Click the presentation image below to access the presentation abstract
    Becca 2

    • Ana Fereirra “Burden of Antibiotic Resistance in Neonates from Developing Societies: Klebsiella pneumoniae in neonatal sepsis”

    Click the presentation image below to access the presentation abstract

    SAVE LIVES: Clean your hands 5th May! The importance of infection control and hygiene in reducing sepsis.

    Infection control plays an important part in reducing the spread of infection-causing bacteria and subsequent antibiotic resistance that reduces treatment options. This is important both in day-to-day life as well as within hospital settings. SAVE LIVES: clean your hands is a global initiative of the WHO to encourage hand washing, preventing transmission of these germs and is coming up on the 5th May. Visit the link for how you can participate and learn more about how simple infection control measures can save lives and reduce instances of life threatening sepsis. (Image credit: WHO, 2018).

    The CDC provides further information on infection control and training basics for both public and healthcare workers

    Click here for CDC infection control advice

    The Infectious Diseases society of America (IDSA) is currently running an online course in infection prevention and control for staff working in a healthcare centre. We encourage all members of BARNARDS staff working with infants to participate in the course and share the link with colleagues

    Take the IDSA infection prevention and control course

    Professor Tim Walsh and the BARNARDS team Nigeria, took part in a “clean hands” initiative 2017 led by Professor Didier Pittet, infectious diseases expert and the director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University Hospital of Geneva.

    Antibiotic resistance week 2017 “Think twice. Seek advice” – UK

    The BARNARDS team in the UK and our associated colleagues contributed to raising AMR awareness by participating in a resistance bake off challenge! The challenge was set to create a cake that had an antibiotic resistance theme… although initially we received some rather perplexed looks, the creativity in the results did not disappoint! The fun and bizarre challenge created a talking point around AMR within the teams and at home with friends and family.


    Our laboratory manager for Medical Microbiology Janice Weeks created this delicious cake which shows the letters representing base pairs, the constructs of DNA, which can carry the genes that encode for antibiotic resistance mechanisms in bacteria.

    antibiotics 1.jpg

    Cake by BARNARDS Technical Specialist Kathryn Thomson:
    Antibiotic resistant infections are historically associated with hospitals due to the selective pressure on bacteria within a clean sterile environment, with antibiotic exposure, an abundance of vulnerable patients and easy transfer between people for resistant bacteria to spread.
    However, animals are featured ingesting these antibiotics. Agricultural use of antibiotics is a breeding ground for resistant bacteria. In regions where this is not regulated, antibiotics are given routinely as a growth promotor or as a “prophylactic treatment” for infection prevention, there by boosting the economics of the industry. In addition to routine antibiotic use having a negative impact on animal physiological health and welfare it’s continued use is allowing resistance to develop in bacteria surviving the treatment, proliferating and spreading to the wider communities through contact. Animal agriculture is not all that is affected, antibiotics are getting into soils and water systems wreaking havoc on delicate ecosystems and generating antibiotic resistance in new environments.

    Brad's Cupcakes.jpg

    Dr Brad Spiller sent in photos of microbiology themed cupcakes featuring a bacterial streak plate used to isolate individual species of bacteria and then determine antibiotic resistance.
    Dr Brad Spiller is part of our wider group in Medical Microbiology looking at antibiotic resistance, leading the UK site for the international reference laboratory in Ureaplasma and Mycoplasma pathogenicity and antimicrobial resistance testing. Brad also has a long standing productive collaboration with Public Health England, developing new clinical diagnostic and microbial typing schemes with focused expertise in determining underlying mechanisms of bacterial antimicrobial resistance, primarily in Mycoplasmas and Ureaplasmas, but expanding into Streptococcus agalactiae and Legionella pneumophilia. The MYCO WELL-D-ONE study has just started enrolling this month and will see Brad and KESS2 funded MPhil student Dan Morris focusing research on sexually transmitted diseases and testing methods.

    Resistance cake1.jpg

    BARNARDS senior technician and administrator Calie Dyer baked a cross section of an Escherichia coli exhibiting known resistance mechanisms. In the top left you can see the effect of antibiotic target modification – antibiotics target specific sites within the bacterial cell that prevent the bacteria from being functional, when the bacteria modify these sites by changing their shape the antibiotic can no longer bind to the site and the antibiotic is rendered ineffective. Bottom left antibiotics are bound within a capsule, bacterial production of enzymes destroy the antibiotic before it is able to function. Bottom middle shows an efflux pump where antibiotics entering the cell are pumped back out through a channel. Bottom right antibiotics are unable to gain entry to the bacterial cell due to a modification to the outer most membrane. Top right show’s a plasmid (a circular piece of DNA) carrying the genes that encode for the resistance mechanisms and can be transferred between cells and bacterial species by horizontal gene transfer…. Unfortunately, there was not enough room on the cake board to show this! multi-drug resistance is occurring with alarming frequency as bacteria can harbour multiple resistance strategies at any one time.

    We look forward to seeing what our partners come up with for next years AMR week!

    In addition, we would like to congratulate the Kano team for their World Sepsis Day efforts making it onto the 2017 Global Sepsis Alliance annual poster. This can be viewed and downloaded Here!

    Antibiotic resistance week 2017 “Think twice. Seek advice”

    In conclusion to our previous posts on antibiotic resistance (AMR) awareness week, we are extremely pleased to see a fantastic response from our partners in Nigeria who have worked incredibly hard to raise awareness through education in their local region and have used BARNARDS findings as a platform to demonstrate the real threat that AMR presents.

    AMR poses a greater risk to those particularly vulnerable to infection, neonates are amongst this group. Where an infection is difficult to treat due to drugs rendered ineffective from resistant bacteria, developing societies may not have easy access to a wider range of antibiotic options further limiting treatment options when resistant bacterial infections emerge with consequent health implications. By educating doctors, nurses, non-clinical hospital staff and the public on responsible administration and use of antibiotics, the lifespan of effective life-saving treatment options can be extended by minimising the rate at which bacterial resistance emerges.

    Read the report below on the Nigerian AMR seminar by Dr Chinagozi Edwin our BARNARDS Kano Clinical Microbiology lead.

    “Organised by BARNARDS study team in conjunction with Murtala Muhammed Specialist Hospital, Kano.


    Antibiotic Awareness Week is a yearly one-week celebration with the overall aim of reducing improper consumption of antibiotics thereby reducing the threat of antimicrobial resistance and keeping antibiotics effective as long as possible in order that those in need can get the best possible treatment.

    This year took place from 13th to 19th of November, 2017. The theme of the programme this year was: “THINK TWICE. SEEK ADVICE (seek advice from a healthcare professional before taking antibiotic)”
    BARNARDS study team in conjunction with Murtala Muhammed Specialist Hospital (MMSH) joined the global community to mark this year’s event with a symposium that took place on 17th November, 2017 at the hospital’s conference hall. The subthemes of the symposium were the problem of antibiotic resistance, burden of antibiotic resistance in Kano and rational use of antibiotics.
    The purpose of the symposium was to:
    1. To raise awareness of the problem of antibiotic resistance among MMSH Community.
    2. To highlight the burden of antibiotic resistance in MMSH and its environs by presenting findings from BARNARDS study antibiograms.
    3. To educate participants on the principles and importance of rational use of antibiotics.

    Project activities
    A meeting was held among the CMD of MMSH and BARNARDS team during which a programme was drawn up including invitation of an Infectious Disease Clinician as a resource person.
    It was also planned that the following would be produced: posters and flex banners and antibiotic awareness promotional customized face caps for improved publicity. Finally, it was agreed that refreshment in form of snacks and soft drinks would be served the participants at the occasion. The hospital took the responsibility of bringing the resource person while BARNARDS took responsibility for the printing and provision of the refreshment. In addition to the posters, advocacy calls were made to various departments of the hospital to enhance attendance.

    QA participants (002)

    The programme was well attended by members of the hospital community with an attendance of over 100 participants, made up of doctors, nurses, students and non-clinical staff.
    The event kicked off with introduction of the resource persons and an opening remark on the event by the CMD.
    The resource persons made their presentations and afterwards questions, a lot of them, were asked by the audience and answers were provided by the resource persons.

    The CMD finally gave a vote of thanks to BARNARDS team for their effort at improving service in MMSH since it came into the institution.
    The attendees asked very poignant questions and commended the programme which showed that the event was a success.


    Recommendations / Follow-up
    1. Need to produce antibiotic awareness promotional posters and leaflets particularly for the medical officers.
    2. Sharing BARNARDS study antibiogram findings with more clinical departments in summarized hard copy form.
    3. Need to extend antibiogram study to the adult patient population.”

    -By Dr Chinagozi Edwin our BARNARDS Kano Clinical Microbiology lead

    Times Before Antibiotics

    What was life like before Sir Alexander Flemming discovered Penicillin?

    In a high income country where antibiotics seem plentiful and free flowing and access to healthcare is readily accessible, it is easy to feel far removed from a world where simple infections could kill and disfigure.

    This is however, a scenario that we are edging ever closer towards as bacteria evolve and acquire resistance mechanisms to combative drugs. Bacterial pathogens, capable of causing illness, are adapting to antibiotic overuse by developing resistance at such a rate that new terms such as “extreme-resistance” and “pan-resistance” are being used and proposed to describe bacteria that are resistant to all known effective antibiotics (Magiorakas et al. 2012). If using antibiotics is driving antibiotic resistance, then it stands to reason the issue of antibiotic resistance is a lot closer to home than many of us realise.

    Take a look at the BBC article written post interview with BARNARDS principal investigator Prof Timothy Walsh, describing life before antibiotics! (Found digging through the archives… you can thank me later Tim)

    Life before antibiotics (and maybe life after an antibiotic apocalypse)

    A.-P. Magiorakos, A. Srinivasan, R.B. Carey, Y. Carmeli, M.E. Falagas, C.G. Giske, S. Harbarth, J.F. Hindler, G. Kahlmeter, B. Olsson-Liljequist, D.L. Paterson, L.B. Rice, J. Stelling, M.J. Struelens, A. Vatopoulos, J.T. Weber, D.L. Monnet, Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance, In Clinical Microbiology and Infection, Volume 18, Issue 3, 2012, Pages 268-281, ISSN 1198-743X,

    World Antibiotic Awareness Week 13-19 November

    “Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.” – WHO, 2017

    “Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill.” WHO, 2017

    Handle with Care: World Antibiotic Awareness week is fast approaching on the 13th-19th November. The BARNARDS team is hoping to rally support and raise awareness for this global cause for concern. Use the link at the end of the post to join the campaign.

    Antimicrobial resistance (AMR) is the ability of a microorganism to prevent an antimicrobial (such as antibiotics) working against it. This results in the treatment no longer being effective and subsequently infections persist and can spread (WHO, 2017). The overuse and misuse of antibiotics causes unnecessary increase in the number and types of antibiotic resistant organisms in a world where new drug discovery has slowed significantly. Sub-optimal concentrations of antibiotics diminish the number of drug susceptible bacteria leaving bacteria with resistance behind to multiply and thrive and pass resistance mechanisms to offspring and other bacteria at an increased rate. Sub-optimal levels of antibiotics can occur where:

    • A prescribed antibiotic course is not finished
    • Where antibiotics are available over the counter, without prescription so an incorrect drug or dose is taken.
    • Receiving poor quality medicines
    • Using antimicrobials as growth-promoters or disease preventative in agriculture or animal rearing.

    Antimicrobial resistance is a growing global problem that affects us all, our options for effective drugs is dwindling at a time where no new novel drugs have appeared in recent years and there is ever growing concern that a simple infection, no matter where in the world you may be, could have a morbid outcome from a lack of available effective treatment.
    As resistant organisms develop and multiply unhindered by combative drugs, their spread to others is exasperated by poor hygiene and infection prevention and control measures at home and in clinical environments. With global travel becoming ever more accessible, so are opportunities for drug resistant mechanisms to spread internationally within short periods of time.

    Neonates in low-middle income countries (LMICs) are particularly at risk from AMR where a significant proportion of neonatal mortalities are believed to be caused by severe infections. In these areas there is a higher burden of bacterial disease and ideal conditions for the emergence and spread of AMR with limited resources to tackle the growing problem (Huynh et al, 2015; WHO, 2017) Information available in this area is limited and it is BARNARDS primary focus to report on the burden of antibiotic resistance in neonates, to determine the scale of the problem, identify the risk factors and contribute towards developing focussed interventions.

    Established through our research will be a reliable international network report on AMR in participating sites amongst LMICs and BARNARDS aims to increase the capability of participating laboratories to detect emerging AMR where prompt action can then be taken by providing microbiological lab support and training.

    How you can help: By reading and sharing the WHO advice given below and visiting the link to learn more and join the WHO 2017 campaign to raise awareness for how the simple measures detailed below can help tackle antimicrobial resistance!

    To prevent and control the spread of antibiotic resistance, individuals can:
    • Only use antibiotics when prescribed by a certified health professional.
    • Never demand antibiotics if your health worker says you don’t need them.
    • Always follow your health worker’s advice when using antibiotics.
    • Never share or use leftover antibiotics.
    • Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.

    Policy makers
    To prevent and control the spread of antibiotic resistance, policy makers can:
    • Ensure a robust national action plan to tackle antibiotic resistance is in place.
    • Improve surveillance of antibiotic-resistant infections.
    • Strengthen policies, programmes, and implementation of infection prevention and control measures.
    • Regulate and promote the appropriate use and disposal of quality medicines.
    • Make information available on the impact of antibiotic resistance.

    Health professionals
    To prevent and control the spread of antibiotic resistance, health professionals can:
    • Prevent infections by ensuring your hands, instruments, and environment are clean.
    • Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
    • Report antibiotic-resistant infections to surveillance teams.
    • Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
    • Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).

    Healthcare industry
    To prevent and control the spread of antibiotic resistance, the health industry can:
    • Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.

    Agriculture sector
    Continue reading World Antibiotic Awareness Week 13-19 November

    World Sepsis Day 13th September

    World sepsis day is celebrated worldwide on the 13th of September each year by the Global sepsis alliance (GSA). One of the BARNARDS objectives is to raise awareness of sepsis by means of educational sepsis training for hospital staff.
    In Kano, Nigeria, the local BARNARDS team organised a sensitisation campaign among the staff of the Murtala Muhammad specialist hospital.

    The main objectives were to raise awareness of health professionals and the general population on the severity of sepsis and to lay emphasis on blood culture and antibiotic driven management.

    In preparation to the event, an advocacy visit was paid to the chief medical director Dr. Nura Idris and the acting HOD of pediatrics Dr. Jamila Ibrahim. They fully pledged their support towards the event. In promotion of sepsis awareness, posters detailing sepsis management and prevention, T-shirts, Key holders and Badges were distributed aimed at disseminating sepsis awareness beyond World Sepsis Day.

    The event took place on Thursday, the 14th September 2017 at the conference room of pediatrics department of Murtala Muhammad specialist hospital. It started at 8:30am and it was chaired by the acting HOD of pediatrics. In attendance were doctors, nurses, community health extension workers and other supporting staff of the hospital. After the opening remarks by the chairperson of the occasion, a brief lecture was given by Dr. Ashiru Yusuf on Neonatal sepsis, as well as some key findings in the ongoing BARNARDS research that could be crucial to the management of neonatal sepsis at the hospital. Dr Jamila Ibrahim then gave a brief lecture on the management of neonatal sepsis with emphasis to choice of antibiotics. The audience were incredibly engaged and through question and answer issues and misconceptions were clarified. The result was people leaving with a better understanding of sepsis it’s causes, signs and effects.
    The event ended at 10:00am and pictures were taken with the staff in attendance who all expressed their happiness for such an event.

    Kano WDS 2

    Kano WDS4

    Kano WDS1

    – Zahra Modibbo, BARNARDS Nigerian Project Implementer, September 2017
    Continue reading World Sepsis Day 13th September