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. 2014 Jan;164(1):61-6.
doi: 10.1016/j.jpeds.2013.09.020. Epub 2013 Oct 16.

Concurrent bloodstream infections in infants with necrotizing enterocolitis

Matthew J Bizzarro  1 , Richard A Ehrenkranz  2 , Patrick G Gallagher  2
Affiliations

Concurrent bloodstream infections in infants with necrotizing enterocolitis

Matthew J Bizzarro et al. J Pediatr. 2014 Jan.

Abstract

Objective: To determine the incidence, microbiology, risk factors, and outcomes related to bloodstream infections (BSIs) concurrent with the onset of necrotizing enterocolitis (NEC).

Study design: We performed a retrospective review of all cases of NEC in a single center over 20 years. BSI was categorized as "NEC-associated" if it occurred within 72 hours of the diagnosis of NEC and "post-NEC" if it occurred >72 hours afterwards. Demographics, hospital course data, microbiologic data, and outcomes were compared via univariate and multivariate analyses.

Results: NEC occurred in 410 infants with mean gestational age and birth weight of 29 weeks and 1290 g, respectively; 158 infants were diagnosed with at least one BSI; 69 (43.7%) with NEC-associated BSI, and 89 (56.3%) with post-NEC BSI. Two-thirds of NEC-associated BSI were due to gram-negative bacilli compared with 31.9% of post-NEC BSI (OR: 4.27; 95% CI: 2.02, 9.03) and 28.5% of all BSI in infants without NEC (OR: 5.02; 95% CI: 2.82, 8.96). Infants with NEC-associated BSI had higher odds of requiring surgical intervention (aOR: 3.51; 95% CI: 1.98, 6.24) and death (aOR: 2.88; 95% CI: 1.39, 5.97) compared with those without BSI.

Conclusions: BSI is a common, underappreciated complication of NEC occurring concurrent with the onset of disease and afterwards. The microbiologic etiology of NEC-associated BSI is different from post-NEC and late-onset BSI in infants without NEC with a predominance of gram-negative bacilli. Infants with NEC-associated BSI are significantly more likely to die than those with post-NEC BSI and NEC without BSI.

Keywords: BPD; BSI; BW; Birth weight; Bloodstream infection; Bronchopulmonary dysplasia; CoNS; Coagulase-negative staphylococci; E coli; Escherichia coli; GA; Gestational age; K pneumoniae; Klebsiella pneumoniae; NEC; NICU; Necrotizing enterocolitis; Neonatal intensive care unit; ROP; Retinopathy of prematurity; TPN; Total parenteral nutrition; VLBW; Very low BW.

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