Khalil N, Blunt HB, Li Z, et al. - Via performing a systematic review, researchers sought to report on bacterial etiology of early onset neonatal sepsis (EOS) in the Middle East. Further, they determined susceptibility patterns to recommended empirical antibiotic therapy and investigated whether high-income and middle-income countries in the region differs in the susceptibility patterns. The analysis was performed on 33 articles from 10 countries including 2,215 cases of culture-positive EOS, excluding coagulase-negative Staphylococcus. The most common pathogens in middle-income countries were Klebsiella species (26%), Staphylococcus aureus (17%) and Escherichia coli (16%), whereas group B Streptococcus (26%), E. coli (24%) and Klebsiella (9%) were most common in high-income countries. In middle-income countries, overall susceptibility to ampicillin/gentamicin and third-generation cephalosporin were 40% and 37%, respectively, vs 93% and 91%, respectively, in high-income countries. Findings thereby indicate involvement of mostly Gram-negative pathogens and less susceptibility to empirical antibiotic therapy in EOS in middle-income countries. This has important public health implications with respect to neonatal mortality in the Middle East region.