title: Pathogens associated with sepsis in newborns and young infants in developing countries.
abstract: BACKGROUND
  Knowledge of pathogens causing infections in young infants (up to 90 days of life) is essential for devising community-based management strategies. Most etiological data from developing countries are hospital-based and may have little relevance to communities in which most babies are born at home.
  
  
  METHODS
  We searched the literature for studies from developing countries reporting etiology of community-acquired infections (sepsis, pneumonia, meningitis) published since 1980. Hospital-based studies reporting early onset sepsis, sepsis among babies admitted from, or born at home were included.
  
  
  RESULTS
  Of 63 studies, 13 focused on community-acquired infections, but limited data were available from home-born neonates. In the first week of life (3209 isolates), Klebsiella species (25%), Escherichia coli (15%), and Staphylococcus aureus (18%) were major pathogens. Group B streptococci (GBS) were relatively uncommon (7%), although regional differences existed. After the first week of life (835 isolates), S. aureus (14%), GBS (12%), Streptococcus pneumoniae (12%), and nontyphoidal Salmonella species (13%) were most frequent. S. pneumoniae (27%) was most common in the postneonatal period (among 141 isolates). Gram-negatives predominated (77%) among home-delivered babies (among 170 isolates).
  
  
  CONCLUSIONS
  Limited information is available on etiology of serious bacterial infections in community settings. Hospital-based studies suggest that most infections in the first week of life are due to Gram-negative pathogens, and many may be environmentally rather than maternally-acquired, owing to unhygienic delivery practices. Such practices may also explain the predominance of Gram-negative infections among home-born infants, although data from home settings are limited. These findings have implications for developing prevention and management strategies in communities and hospitals.
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. anita.zaidi@aku.edu
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Durrane
authors.initials: D
authors.lastname: Thaver
authors.forename: Syed Asad
authors.initials: SA
authors.lastname: Ali
authors.forename: Tauseef Ahmed
authors.initials: TA
authors.lastname: Khan
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D003906:Developing Countries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology*