Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery

Abstract

Purpose: Anastomotic leakage (AL) is a type of intra-abdominal infection (IAI) which requires appropriate antibiotics with proper intervention. This study aimed to improve the appropriateness of antibiotic treatment by assessing the patterns of antibiotic treatment and resistance of pathogen profiles in patients who had AL after colorectal cancer surgery. Methods: From June 2006 through December 2017, the medical records of the patients who had AL after elective abdominal surgery for colorectal cancer in Kyung Hee University Hospital at Gangdong, Seoul, Korea were reviewed retrospectively. Baseline characteristics and consistence of antibiotics with culture study results were analyzed to evaluate the appropriateness of treatment. Results: Among 982 patients who underwent primary surgery for colorectal cancer, 41 (4.2%) had AL. Mean time of diagnosis of AL from surgery was 6.3 days. The most commonly used prophylactic antibiotics for the primary surgery was 2nd generation cephalosporin (66.6%). Mean duration of prophylactic antibiotics usage was 2.8 days. The most commonly used empirical antibiotics after AL occurred was piperacillin and tazobactam (32.6%). Mean duration of empirical antibiotics usage was 8.2 days. The most commonly identified pathogens were Escherichia coli and Enterococci spp. (26.8% each), and 12.2% of the "ESKAPE" pathogens were identified. Resistance to empirical antibiotics was 45.5% (10/22). Conclusion: Penetration of culture study for AL after colorectal cancer surgery appeared relatively low, although the profile of pathogens isolated from the AL patients can give important clues and evidence for appropriate antibiotics use. Surgeons should pay attention in performing culture studies for IAI including AL for proper patient treatment.

The Colorectal Cancer Gut Environment Regulates Activity of the Microbiome and Promotes the Multidrug Resistant Phenotype of ESKAPE and Other Pathogens

“…Furthermore, colorectal cancer patients often require post-surgical antibiotic treatments to fight infections by E. coli , Enterococci spp. and “ESKAPE” pathogens, of which ~45% are AB resistant ( 12 ). ESKAPE species comprise Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacter spp., and are of great clinical significance, causing nosocomial (hospital acquired) infections while possessing resistance to a broad spectrum of commonly used antibiotics.…”

Possible role of features of the intestinal microbiome in patients with colorectal cancer as a cause of anastomotic leak

“…Отдельные авторы рекомендуют использовать антибиотики в послеоперационном периоде, действующие на Escherichia coli и Enterococci как на наиболее частые патогены [49,50]. Хотя некоторые современные авторы предлагают использовать в качестве предоперационной подготовки такие антибиотики, как гентамицин в сочетании с эритромицином [20].…”

Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

“…Accordingly, few AL patients have cultures sent of their pathogens to guide the antibiotic treatment regimen. One study from Korea examined nearly 1,000 patients undergoing elective surgery for the treatment of primary colorectal cancer, finding 4.2% experienced AL, and only 53.7% had culture studies for intra-abdominal fluid or abscess performed 21. To determine the bacteria present in an AL, the CIAOW (Complicated intra-abdominal infections worldwide observational study) collected data from 1,898 patients in 68 medical institutions worldwide, finding the top pathogens from intraabdominal infections to be Escherichia coli (35.7%), Enterococcus (12.9%), Klebsiella (10.5%), Pseudomonas aeruginosa (5.1%), and Enterobacter spp.…”