Concurrent bloodstream infections in infants with necrotizing enterocolitis

Area of Science:

• Neonatalogy
• Infectious Diseases
• Pediatric Surgery

Background:

• Necrotizing enterocolitis (NEC) is a serious gastrointestinal condition in premature infants.
• Bloodstream infections (BSIs) are a frequent complication in infants with NEC.
• Understanding the characteristics of BSIs in NEC is crucial for improving outcomes.

Purpose of the Study:

• To investigate the incidence, microbiology, risk factors, and outcomes of bloodstream infections (BSIs) associated with necrotizing enterocolitis (NEC).
• To differentiate between BSIs occurring concurrently with NEC onset versus those developing later.

Main Methods:

• Retrospective review of 410 NEC cases over 20 years at a single center.
• Categorization of BSIs as 'NEC-associated' (within 72 hours of NEC diagnosis) or 'post-NEC' (>72 hours).
• Comparison of demographics, clinical data, microbiology, and outcomes using univariate and multivariate analyses.

Main Results:

• 158 infants (38.5%) had at least one BSI; 69 were NEC-associated, 89 were post-NEC.
• NEC-associated BSIs showed a higher prevalence of gram-negative bacilli (two-thirds) compared to post-NEC BSIs (31.9%).
• Infants with NEC-associated BSIs had significantly higher odds of requiring surgery (aOR: 3.51) and death (aOR: 2.88).

Conclusions:

• Bloodstream infections are a common and significant complication of necrotizing enterocolitis.
• The microbiological profile of NEC-associated BSIs differs from post-NEC and other late-onset BSIs, with a notable increase in gram-negative pathogens.
• NEC-associated BSIs are linked to substantially worse outcomes, including increased mortality.