Synergy in Necrotizing Enterocolitis

Sir. —Guinan et al recently reported an investigation of outbreaks of neonatal necrotizing enterocolitis (NEC) (Journal1979;133:594-597). Their observation that the disease occurred as epidemics and was delayed by prior use of antibiotics suggested an infectious etiology. No single organism has been isolated from all cases of NEC. However, these authors found that 75% of the infants studied from one hospital and 13% from another were infected by Klebsiella pneumoniae. Klebsiella has also been associated with other outbreaks of NEC 1,2 or isolated from single cases. 3 Guinan et al conclude that Klebsiella could be a contributory agent and suggest that in future outbreaks, all aerobes and anaerobes should be identified from the stool flora to allow an assessment of whether one or a combination of organisms could be responsible. These workers did not test for anaerobes. Howard et al 4 attributed an epidemic of NEC in the Special Care