Successful Clinical Avoidance of Colorectal Anastomotic Leakage through Local Decontamination

Gerhard Ernst Steyer; Markus Puchinger; Johann Pfeifer

doi:10.3390/antibiotics13010079

Successful Clinical Avoidance of Colorectal Anastomotic Leakage through Local Decontamination

Antibiotics (Basel). 2024 Jan 15;13(1):79. doi: 10.3390/antibiotics13010079.

Authors

Gerhard Ernst Steyer^{1

2}, Markus Puchinger³, Johann Pfeifer¹

Affiliations

¹ Division of General, Visceral and Transplant Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria.
² Doctoral School of Lifestyle-Related Diseases, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
³ Medical Engineering and Computing, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.

Abstract

Aim: An anastomotic leak is an unpredictable postoperative complication during recovery from colorectal surgery that may require a re-operation. Potentially pathogenic bacteria like Pseudomonas (and Enterococcus) contribute to the pathogenesis of an anastomotic leak through their capacity to degrade collagen and to activate tissue matrix metalloprotease-9 in host intestinal tissues. The microbiome, therefore, is the key to preventing an anastomotic leak after colorectal surgery. The aim of this trial was to investigate whether perioperative selective decontamination with a new mixture of locally acting antibiotics specially designed against Pseudomonas aeruginosa and Enterococcus faecalis can reduce or even stop early symptomatic leakage.

Method: All hospitalized patients in our University Clinic undergoing colorectal surgery with a left-sided anastomosis were included as two groups; patients in the intervention group received polymyxin B, gentamicin and vancomycin every six hours for five postoperative days and those in the control group did not receive such an intervention. An anastomotic leak was defined as a clinically obvious defect of the intestinal wall integrity at the colorectal anastomosis site (including suture) that leads to a communication between the intra- and extraluminal compartments, requiring a re-do surgery within seven postoperative days.

Results: Between February 2017 and May 2023, a total of 301 patients (median age of 63 years) were analyzed. An anastomotic leak was observed in 11 patients in the control group (n = 152), but in no patients in the intervention group (n = 149); this difference was highly significant.

Conclusion: The antibiotic mixture (with polymyxin B, gentamicin and vancomycin) used for local decontamination in our study stopped the occurrence of anastomotic leaks completely. According to the definition of anastomotic leak, no further surgery was required after local perioperative decontamination.

Keywords: E. faecalis; P. aeruginosa; anastomotic leak; antibiotics; colorectal surgery; gentamicin; local decontamination.

Grants and funding

This research received no external funding. This trial was investigator-initiated and investigator-driven and designed for a doctoral thesis at the Medical University of Graz (Doctoral School of Lifestyle-Related Diseases) by G.E.S. under the supervision of J.P. and M.P.