Nineteen studies reported data for the entire neonatal period (Zaidi AKM, 2007; unpublished data) (Table 2). 10,12,15,17,19,21–28,31,34–37 A total of 2594 isolates were community-acquired or adjudged predominantly community-acquired (see Table 1 for rationale for studies adjudged to be community-acquired). Gram-negatives predominated in aggregated data (Gram-negative to Gram-positive ratio 1.6:1) and 3 organisms S. aureus, E. coli, and Klebsiella species caused nearly half (44%) of all infections. This pattern was repeated across East Asia and Pacific,10,24,25,31 Middle East and Central Asia,21,34,35 and South Asian regions15,17,22,28 (Zaidi AKM, 2007; unpublished data), although certain differences were noted: Pseudomonas species were less frequent in the Middle Eastern and Central Asian region, and in South Asia fewer S. aureus and E. coli, and comparatively more Klebsiella species were isolated. GBS was infrequent in East Asia and Pacific regions. In the African region,12,19,23,26,27,36,37 however, GBS, Streptococcus pneumoniae, and Streptococcus pyogenes, in addition to S. aureus were most frequent, with an overall Gram-positive predominance. Also in contrast to other regions, the most frequent Gram-negative isolates in the African region were nontyphoidal Salmonella species.
Although GBS–relative to other organisms and relative to data from industrialized countries2,4–were not as frequently reported, particularly in the first week of life, they appear common in African countries and very uncommon in the South Asian region. However, intercountry variations are also apparent, with some South Asian reports suggesting higher prevalence of GBS28,45,76 and some African reports the converse, or even no GBS isolates.14,20,26,38,51,52,59,77 The reasons for such inter-regional variations are not clearly understood, and variations in risk factors such as vaginal colonization, strain virulence, antibody levels, or cultural practices are thought to contribute.4
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