Polymerase chain reaction for Enterococcus faecalis in drain fluid: the first screening test for symptomatic colorectal anastomotic leakage. The Appeal-study: Analysis of Parameters Predictive for Evident Anastomotic Leakage

Komen, Niels; Slieker, Juliette; Willemsen, Paul; Mannaerts, G. H. H.; Pattyn, Piet; Karsten, Thomas; Wilt, Hans de; Harst, Erwin van der; Leeuwen, Willem van; Decaestecker, Christine; Jeekel, Hans; Lange, Johan F.

doi:10.1007/s00384-013-1776-8

Cited by 36 publications

(31 citation statements)

References 28 publications

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“…It is important to recognize, however, that parenteral cefoxitin did not kill E. faecalis in our rat model nor did it prevent leakage. It is noteworthy that the most commonly used antibiotics in colon surgery (i.e., second and third generation cephalosporins) do not eliminate E. faecalis in the gut, but in fact allow it to proliferate and predominate (29, 50, 51). Although many have advocated the use of non-absorbable oral antibiotics in colon surgery including the use of a combination of oral kanamycin and erythromycin (52), whether they actually eliminate collagen-degrading E. faecalis and other such organisms from anastomotic tissues remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak

et al. 2015

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Even under the most expert care, a properly constructed intestinal anastomosis can fail to heal resulting in leakage of its contents, peritonitis and sepsis. The cause of anastomotic leak remains unknown and its incidence has not changed in decades. Here, we demonstrate that the commensal bacterium Enterococcus faecalis contributes to the pathogenesis of anastomotic leak through its capacity to degrade collagen and to activate tissue matrix metalloprotease-9 (MMP9) in host intestinal tissues. We demonstrate in rats that leaking anastomotic tissues were colonized by E. faecalis strains that showed an increased collagen-degrading activity and also an increased ability to activate host MMP9, both of which contributed to anastomotic leakage. We demonstrate that the E. faecalis genes gelE and sprE were required for E. faecalis-mediated MMP9 activation. Either elimination of E. faecalis strains through direct topical antibiotics applied to rat intestinal tissues or pharmacological suppression of intestinal MMP9 activation prevented anastomotic leak in rats. In contrast, the standard recommended intravenous antibiotics used in patients undergoing colorectal surgery did not eliminate E. faecalis at anastomotic tissues nor did they prevent leak in our rat model. Finally, we show in humans undergoing colon surgery and treated with the standard recommended intravenous antibiotics, that their anastomotic tissues still contained E. faecalis and other bacterial strains with collagen-degrading/MMP9 activity. We suggest that intestinal microbes with the capacity to produce collagenases and to activate host metalloproteinase MMP9 may break down collagen in the gut tissue contributing to anastomotic leak.

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Section: Discussionmentioning

confidence: 99%

Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak

et al. 2015

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“…76 82 Importantly, the gelatinase GelE of Enterococcus faecalis has been shown to degrade collagen, a critical component of anastomotic tissue healing (figure 3). 83 Although little is known about E. faecalis and its possible influence on leakage, this bacterium is highly prevalent in leaking anastomotic tissues 84 85 . Enterococcus has a high adherence affinity to extracellular cellular matrix proteins such as fibronectin, laminin and various different types of collagens,86–88 including collagen IV 89…”

Section: Influence On and Changes In The Gut Microbiota After Intestimentioning

confidence: 99%

“…In a recent clinical study, Komen et al 85 proposed a feasible fast-screening tool for the early detection of colorectal AL based on the presence of Escherichia coli and E. faecalis in drained fluid using RT-PCR. They showed that the increased presence of E. faecalis in drained fluid may be a sensitive screening tool for the early detection of colorectal AL, while negative test results virtually rule out the presence of an anastomotic leak.…”

Section: Influence On and Changes In The Gut Microbiota After Intestimentioning

confidence: 99%

Novel insight into the role of microbiota in colorectal surgery

Bachmann

Diller

Delzenne

et al. 2017

Gut

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Recent literature undeniably supports the idea that the microbiota has a strong influence on the healing process of an intestinal anastomosis. Understanding the mechanisms by which the bacterial community of the gut influences intestinal healing could open the door for new preventive and therapeutic approaches. Among the different mechanisms, data have shown that the production of specific reactive oxygen species (ROS) and the activation of specific formyl peptide receptors (FPRs) regulate intestinal wound healing. Evidence suggests that specific gut microbes such as spp and help to regulate healing processes through both ROS-dependent and FPR-dependent mechanisms. In this review, we will discuss the current knowledge and future perspectives concerning the impact of microbiota on wound healing. We will further review available evidence on whether mechanical bowel preparation and the use of specific antibiotics are beneficial or harmful procedures, an ongoing matter of debate. These practices have a profound effect on the gut microbiota composition at the level of both the mucosal and the luminal compartments. Therefore, a key question remains unanswered: Current knowledge and data do not clearly support the use of one technique or another to avoid complications such as anastomotic leak. There is an urgent need for appropriate interventions with a deep microbiota analysis to investigate both the surgical technical benefits of a proper anastomosis compared with the potential effect of the gut microbes (beneficial vs harmful) on the processes of wound healing and anastomotic leakage reduction.

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“…159 Similarly, other studies have shown that PCR-detection of Enterococcus in drain fluid after colorectal surgery correlated with those patients that developed anastomotic leakage. 160 …”

Section: The Microbial Hypothesis Of Anastomotic Leakmentioning

confidence: 99%

The intestinal microbiome and surgical disease

Krezalek

Skowron

Guyton

et al. 2016

Current Problems in Surgery

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Polymerase chain reaction for Enterococcus faecalis in drain fluid: the first screening test for symptomatic colorectal anastomotic leakage. The Appeal-study: Analysis of Parameters Predictive for Evident Anastomotic Leakage

Abstract: Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.

Cited by 36 publications

References 28 publications

Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak

Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak

Novel insight into the role of microbiota in colorectal surgery

The intestinal microbiome and surgical disease

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