CONCORDANCE OF BACTERIAL CULTURES WITH ENDOTOXIN AND INTERLEUKIN-6 INNECROTIZING ENTEROCOLITIS

Concordance between gram-negative enteric and other toxin-producing ba cteria in blood and stool culture, endotoxin (lipopolysaccharide), and interleukin-6 (IL-6) was measured in 60 preterm infants (600-1600 g) as a clinical index in neonatal necrotizing enterocolitis (NEC). E. co li, Klebsiella, Enterobacter, and Clostridium spp., identified by rout ine bacteriology, were each strongly associated with elevated concentr ations of endotoxin (P < 0.01) in stool filtrates, with Clostridium sp p. most strongly associated 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 notably elevated levels of stool endotoxin (>10 ln EU/g) compar ed to NEC-negative (47%) samples tested. Plasma and stool IL-6 general ly tested at the low, nonmeasurable limit of the ELISA for NEC-negativ e (88%) and stage I NEC (93%), although a small proportion of samples (25%) from infants with stage II or III NEC had elevated stool concent rations of IL-6. We conclude that identification of toxin-producing or ganisms and endotoxin elevations in stool filtrates are more useful th an circulating levels of endotoxin in plasma in predicting mucosally l imited disease in the gastrointestinal tract. The prognostic value of monitoring stool endotoxin in infants with overgrowth of gram-negative bacteria has implications for therapeutic strategies in patients with early and advanced stages of disease. Monitoring inflammatory cytokin es (IL-6) in relation to endotoxin values in stool appears of limited clinical value in controlling this devastating disease in preterm neon ates.