title: Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the aetiology and antibiotic resistance patterns of community-acquired sepsis in developing countries in infants where no clear focus of infection is clinically identified. To estimate the likely efficacy of WHO's recommended treatment for infant sepsis.
  
  
  METHODS
  A systematic review of the literature describing the aetiology of community-acquired neonatal and infant sepsis in developing countries. Using meta-analytical methods, susceptibility was determined to the antibiotic combinations recommended by WHO: (1) benzylpenicillin/ampicillin and gentamicin, (2) chloramphenicol and benzylpenicillin, and (3) third-generation cephalosporins.
  
  
  RESULTS
  19 studies were identified from 13 countries, with over 4000 blood culture isolates. Among neonates, Staphylococcus aureus, Klebsiella spp. and Escherichia coli accounted for 55% (39-70%) of culture positive sepsis on weighted prevalence. In infants outside the neonatal period, the most prevalent pathogens were S aureus, E coli, Klebsiella spp., Streptococcus pneumoniae and Salmonella spp., which accounted for 59% (26-92%) of culture positive sepsis. For neonates, penicillin/gentamicin had comparable in vitro coverage to third-generation cephalosporins (57% vs. 56%). In older infants (1-12 months), in vitro susceptibility to penicillin/gentamicin, chloramphenicol/penicillin and third-generation cephalosporins was 63%, 47% and 64%, respectively.
  
  
  CONCLUSIONS
  The high rate of community-acquired resistant sepsis-especially that caused by Klebsiella spp. and S aureus-is a serious global public health concern. In vitro susceptibility data suggest that third-generation cephalosporins are not more effective in treating sepsis than the currently recommended antibiotics, benzylpenicillin and gentamicin; however, with either regimen a significant proportion of bacteraemia is not covered. Revised recommendations for effective second-line antibiotics in neonatal and infant sepsis in developing countries are urgently needed.
authors.affiliation: Centre for International Child Health, Department of Paediatrics, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, VIC 3052, Australia.
authors.forename: Lilian
authors.initials: L
authors.lastname: Downie
authors.forename: Raffaela
authors.initials: R
authors.lastname: Armiento
authors.forename: Rami
authors.initials: R
authors.lastname: Subhi
authors.forename: Julian
authors.initials: J
authors.lastname: Kelly
authors.forename: Vanessa
authors.initials: V
authors.lastname: Clifford
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000379:methods; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000382:microbiology; D003906:Developing Countries; D004352:Drug Resistance, Microbial; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014944:World Health Organization
chemical_list: D000900:Anti-Bacterial Agents