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Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis

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  • Sophie C H Wen
  • Yukiko Ezure
  • Lauren Rolley
  • Geoff Spurling
  • Colleen L Lau
  • Saba Riaz
  • David L Paterson
  • Adam D Irwin

Abstract

Background: Neonatal sepsis is a significant global health issue associated with marked regional disparities in mortality. Antimicrobial resistance (AMR) is a growing concern in Gram-negative organisms, which increasingly predominate in neonatal sepsis, and existing WHO empirical antibiotic recommendations may no longer be appropriate. Previous systematic reviews have been limited to specific low- and middle-income countries. We therefore completed a systematic review and meta-analysis of available data from all low- and lower-middle-income countries (LLMICs) since 2010, with a focus on regional differences in Gram-negative infections and AMR. Methods and findings: All studies published from 1 January 2010 to 21 April 2021 about microbiologically confirmed bloodstream infections or meningitis in neonates and AMR in LLMICs were assessed for eligibility. Small case series, studies with a small number of Gram-negative isolates (

Suggested Citation

  • Sophie C H Wen & Yukiko Ezure & Lauren Rolley & Geoff Spurling & Colleen L Lau & Saba Riaz & David L Paterson & Adam D Irwin, 2021. "Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 18(9), pages 1-20, September.
    • Handle: RePEc:plo:pmed00:1003787
    DOI: 10.1371/journal.pmed.1003787
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