title: Bloodstream infections in very low birth weight infants with intestinal failure.
abstract: OBJECTIVE
  To examine pathogens and other characteristics associated with late-onset bloodstream infections (BSIs) in infants with intestinal failure (IF) as a consequence of necrotizing enterocolitis (NEC).
  
  
  METHODS
  Infants weighing 401-1500 g at birth who survived for >72 hours and received care at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers were studied. The frequency of culture-positive BSI and pathogens were compared in infants with medically managed NEC, NEC managed surgically without IF, and surgical IF. Among infants with IF, the duration of parenteral nutrition (PN) and other outcomes were evaluated.
  
  
  RESULTS
  A total of 932 infants were studied (IF, n = 78; surgical NEC without IF, n = 452; medical NEC, n = 402). The proportion with BSI after diagnosis of NEC was higher in the infants with IF than in those with surgical NEC (P = .007) or medical NEC (P < .001). Gram-positive pathogens were most frequent. Among infants with IF, an increased number of infections was associated with longer hospitalization and duration of PN (median stay: 172 for those with 0 infections, 188 days for those with 1 infection, and 260 days for those with ≥2 infections [P = .06]; median duration of PN: 90, 112, and 115 days, respectively [P = .003]) and decreased achievement of full feeds during hospitalization (87%, 67%, and 50%, respectively; P = .03).
  
  
  CONCLUSIONS
  Recurrent BSIs are common in very low birth weight infants with IF. Gram-positive bacteria were the most commonly identified organisms in these infants.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. conrad.cole@cchmc.org
authors.forename: Conrad R
authors.initials: CR
authors.lastname: Cole
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
mesh_terms: D017848:Blood-Borne Pathogens; D020345:Enterocolitis, Necrotizing / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D011446:Prospective Studies; D012778:Short Bowel Syndrome / Q000150:complications*