Concordance of Bacterial Cultures with Endotoxin and Interleukin-6 in Necrotizing Enterocolitis
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- Duffy, L.C., Zielezny, M.A., Carrion, V. et al. Dig Dis Sci (1997) 42: 359. doi:10.1023/A:1018826204819
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Concordance between gram-negative enteric andother toxin-producing bacteria in blood and stoolculture, endotoxin (lipopolysaccharide), andinterleukin-6 (IL-6) was measured in 60 preterm infants(600-1600 g) as a clinical index in neonatal necrotizingenterocolitis (NEC). E. coli, Klebsiella, Enterobacter,and Clostridium spp., identified by routinebacteriology, were each strongly associated withelevated concentrations of endotoxin (P < 0.01) instool filtrates, with Clostridium spp. most stronglyassociated with NEC disease. Stool filtrate endotoxin(EU/g) measured by a Limulus amebocyte lysate assay was age dependent. Samples from stage I NEC (61%)and infants with advanced disease (67%) had notablyelevated levels of stool endotoxin (>10 ln EU/g)compared to NEC-negative (47%) samples tested. Plasmaand stool IL-6 generally tested at the low,nonmeasurable limit of the ELISA for NEC-negative (88%)and stage I NEC (93%), although a small proportion ofsamples (25%) from infants with stage II or III NEC had elevated stool concentrations of IL-6. Weconclude that identification of toxin-producingorganisms and endotoxin elevations in stool filtratesare more useful than circulating levels of endotoxin in plasma in predicting mucosally limited diseasein the gastrointestinal tract. The prognostic value ofmonitoring stool endotoxin in infants with overgrowth ofgram-negative bacteria has implications for therapeutic strategies in patients with earlyand advanced stages of disease. Monitoring inflammatorycytokines (IL-6) in relation to endotoxin values instool appears of limited clinical value in controlling this devastating disease in pretermneonates.