Article
Surveillance and Gut Microbiomics in Neonatal Sepsis in Tanzania (MS-GM-NST) – an academic partnership study at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania
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Authors
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Fatima Mussa
- Pediatrics & Child Health Dep., Muhimbili Univ. of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Agricola Joachim
- Dep. of Microbiology & Immunology, MUHAS, Dar es Salaam, Tanzania
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Robert Moshiro
- Dep. of Paediatrics & Child Health, MNH, Dar es Salaam, Tanzania
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Martha Mkony
- Dep. of Paediatrics & Child Health, MNH, Dar es Salaam, Tanzania
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Monica G. Appollo
- Dep. of Paediatrics & Child Health, MNH, Dar es Salaam, Tanzania
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Salim Masoud
- Dep. of Microbiology, MNH, Dar es Salaam, Tanzania
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Fine Ferenz
- Institute for Infection Research & Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Jona Ohlhoff
- Institute for Infection Research & Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Julia Pagel
- Dep. of Pediatrics, UKE, Hamburg, Germany
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Nahya S. Masoud
- Pediatrics & Child Health Dep., Muhimbili Univ. of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Robin Kobbe
- Institute for Infection Research & Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Dep. of Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| Published: | November 4, 2024 |
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Outline
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Research question and project description: Despite advancements in reducing child mortality, neonatal mortality rates remain high in many low- and middle-income countries (LMICs). Neonatal sepsis and the escalating threat of antimicrobial resistance (AMR) pose significant challenges in LMICs. Understanding the epidemiology of neonatal sepsis and AMR is crucial for developing effective treatment and prevention strategies. Gut dysbiosis has been described as a significant risk factor for late-onset sepsis (LOS) in preterm infants. Recognizing gut dysbiosis and its impact on LOS risk may enhance the predictive value of microbiome patterns, offering avenues for targeted interventions like probiotics for high-risk preterm infants.
Objectives and methods: The MS-GM-NST study, funded by the GIZ academic Hospital Partnership program, aims to identify risk factors, causative bacterial pathogens and AMR prevalence in neonatal LOS at MNH, Dar es Salaam, Tanzania. Supported by our German counterparts, we aim to employ a translational approach on fresh fecal samples to characterize the gut microbiome by metagenomic sequencing, improve AMR surveillance, microbiological diagnostics and clinical care. Our team collects clinical data, blood cultures and fresh frozen fecal samples from preterm infants born between 28+0 and <34 weeks of gestational age at MNH. Participants will be enrolled with parental consent and prospectively followed until 28 days of life. Endpoints include suspected and blood culture-proven LOS, deaths due to sepsis, deaths from any cause, and hospital discharge. DNA extracted from fecal samples of 50 infants with culture-proven LOS and a sufficient number of controls will be analyzed for microbial community function using microbial metabolic network modeling. A pilot colonization screening for potential pathogens will be established to evaluate its role in AMR surveillance.
First results and discussion: We report challenges in study implementation at MNH, in a large neonatal department within a low-resource setting. These include limited infrastructure and supplies, trained human resources, and financial constraints. Despite the logistical hurdles, the study endeavors to enroll adequate participants with culture-proven LOS, establish colonization screening, and characterize local gut microbiomes. The study aims to establish an academic partnership by contributing data to improve clinical care, AMR surveillance, and understanding microbiome patterns in the Tanzanian setting.
