2327. Microbiology and Prognostic Significance of Blood Stream Infections in Necrotizing Enterocolitis
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 6, 2018
Room: S Poster Hall
Background: Necrotizing enterocolitis (NEC) is the most severe and frequent gastrointestinal disease seen in neonatal intensive care units. The purpose of this study is to characterize and correlate disease severity and survival in NEC patients with bloodstream infections (BSI).

Methods: An institutional database was retrospectively reviewed for all infants with NEC (Bell’s stage II or III) between April 1, 2016 and November 2, 2017. Standard statistical methods were utilized to analyze demographics, need for surgery, survival, and blood culture results. Chi-squared was used to compare categorical variables, t-test for continuous variables, and Cox proportional hazards model for survival analysis. A p-value <0.05 was considered significant.

Results: The cohort consisted of 70 infants with NEC with 11 (16%) having concurrent BSI. Demographics and disease severity were similar between +BSI and –BSI patients (Table 1). Blood cultures from +BSI patients identified Klebsiella (36%), S. Epidermidis (36%), E. coli (18%), and S. Aureus (9%). Positive BSI patients were more likely to require surgery (54.6% vs 17.0%, p<0.011). There was a trend toward higher mortality in +BSI patients (p=0.145), which is reflected in a Kaplan-Meier curve. Significant risk factors for mortality were African American race (p=0.040), lack of enteral feeds prior to onset (p=0.014) and need for surgery (p=0.002).

Conclusion: This retrospective cohort study elucidated the microbiology related to NEC at a single center and revealed an association between concurrent bloodstream infections and increased disease severity and need for surgery.

Table 1 - Demographics
BSI + (n=11) BSI - (n=59) p-value
Gender (M) 3 (27.3) 29 (49.2) 0.173
African American 6 (54.6) 31 (52.5) 0.064
Hispanic 2 (18.2) 25 (42.4) 0.064
Non-Hispanic White 3 (27.3) 3 (5.1) 0.064
Gestational age (wks) 28.0(2.53) 27.6(4.56) 0.771
Bell Stage 3 9 (81.8) 39 (66.1) 0.280
Surgery 5 (54.6) 10 (17.0) 0.011

Table 2 - Survival Analysis
Factor Risk Ratio 95% CI p-value
+ BSI 5.3 0.5-56.6 0.145
Male 1.0 1.0-5.3 0.976
African American 4.7 1.1-33.0 0.040
No enteral feeds 5.8 1.5-25.3 0.014
Surgery 17.0 2.8-150.4 0.002
Recurrence 2.9 0.2-11.4 0.172

Thomas Boyle, BS1, Rebecca Starker, BS2, Ashira Morgan, BS1, Misha Tori Armstrong, B.S. Biology2, Anna Moscowitz, BS1, Laurence Lindenmaier, BS1, Megan McSherry, BS1, Lukas Gaffney, BS1, Julia Amundson, BS1, Samantha Greissman, BA, MPH2, Chad Thorson, MD2, Eduardo Perez, MD2, Anthony Hogan, MD3, Ann-Christina Brady, MD2, Juan Sola, MD4 and Holly Neville, MD4, (1)University of Miami, Miami, FL, (2)University of Miami Miller School of Medicine, Miami, FL, (3)University of Miami Miller School of Medicine, Miamie, FL, (4)University of Miami Miller School of Medicine, miami, FL

Disclosures:

T. Boyle, None

R. Starker, None

A. Morgan, None

M. T. Armstrong, None

A. Moscowitz, None

L. Lindenmaier, None

M. McSherry, None

L. Gaffney, None

J. Amundson, None

S. Greissman, None

C. Thorson, None

E. Perez, None

A. Hogan, None

A. C. Brady, None

J. Sola, None

H. Neville, None

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