UC Irvine

Objective To examine the microbiology and outcomes related to bloodstream infections (BSIs) in neonates with intestinal failure (IF) due to necrotizing enterocolitis (NEC).

Study Design I performed a retrospective review of very low birth weight (VLBW) neonates with late-onset BSI at a single center over 8.5 years. Recurrence and frequencies of BSI pathogens were compared between neonates with and without IF. Pathogen frequencies and mortality were compared for NEC-associated BSI (≤72 hours from NEC diagnosis) and post-NEC BSI (>72 hours after NEC diagnosis) in neonates with and without IF.

Results 177 neonates with 234 BSIs were studied. Compared to other VLBW neonates with BSI, IF patients (n=45) suffered more often from recurrent BSI (44% vs. 20%, p=0.01), and frequently had gut-bacteria BSI (51% vs. 28%, p=0.01). NEC-associated BSIs in IF patients had similar pathogen profiles to BSIs in other VLWB neonates, while post-NEC BSIs in IF patients were more commonly due to gut bacteria (48% vs. 23%, p<0.00). Mortality for IF patients with post-NEC BSI was the same as for the cohort as a whole (17%). IF patients with NEC-associated BSI had higher odds of death (OR 3.9) than other neonates (35% vs. 15%, p=0.02).

Conclusions IF patients commonly have recurrent BSI and gut-bacteria BSI. The microbiologic etiology of post-NEC BSI in neonates with IF is different from BSI in other VLBW neonates, and is more commonly of gut origin. IF patients with NEC-associated BSI have a significantly higher odds of death than other VLBW neonates with BSI.