2327. Microbiology and Prognostic Significance of Blood Stream Infections in Necrotizing Enterocolitis

Background Necrotizing enterocolitis (NEC) is the most severe and frequent gastrointestinal disease seen in neonatal intensive care units. The purpose of this study was 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 < 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 (weeks) 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) 0.011Table 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 Disclosures All authors: No reported disclosures.