Table 3.
Bacterial findings
| Author | Type of surgery | Collagenase bacteria | Other results | Comments |
|---|---|---|---|---|
| Anderson et al. [34] | Colon or rectal resection |
Present in 73.7% of AL patients E. faecalis present in 36.8% of AL patients |
- | - |
| Baker et al. [35] | Colon or rectal resection | Clostridioides difficile |
AL with CDI 3.52% AL without CDI 1.44% |
CDI increases risk of AL (OR 2.39; 95%CI 1.70–3.36; p < 0.001) |
| Bilgin et al. [36] | Rectal resection | Proteus spp. and Klebsiella pneumoniae were found only in AL patients | AL patients culture-positive on POD1 (28.6%), POD3 (42.9%), and POD5 (85.7%), compared with 9.3%, 7%, and 11.6% in non-AL | All AL occurred in patients with stapled anastomosis (p = 0.325) |
| Calu et al. [37] | Colon or rectal resection, or colectomy | Clostridium difficile |
AL in 68.4% who developed CDI after surgery AL was associated with CDI (RR 13.7; 95%CI 7.68–24.5; p < 0.0001) |
AL patients all had left-sided or rectal resection |
| Fouda et al. [38] | Rectal resection | E. coli ↑, Klebsiella ↑, Bacteroides ↑ and Pseudomonas spp. ↑ in AL vs. non-AL group | 85% of non-AL patients had negative cultures, and the remaining 7 only limited growth of E. coli, Klebsiella and Pseudomonas | - |
| Jin et al. [39] | Colon resection | Bacteroides spp. |
AL-patients: Romboustia, Blautia, Bacteroides and Eggerthella ↑, Clostridium sensu stricto 1 ↑, Ruminococcus gnavus ↑ Non-AL patients: Lactobacillus and Comamonas genera both ↑ |
Alpha-diversity of postoperative fecal samples was significantly higher in the AL group vs. non-AL group |
| Komen et al. [40] | Colon or rectal resection, or colectomy |
E. faecalis ↑ on POD2-4 E. coli ↑ on POD4-5 |
No presence of E. faecalis on POD3, had a high negative predictive value (99%) and sensitivity (93%) for later AL | False positive results could be due to subclinical AL |
| Li et al. [41] | Colon or rectal resection | No |
AL-group: Corynebacterium suicordis, Porphyromonas asaccharolytica, Vibrio diazotrophicus, and Clostridium leptum all ↑ Non-AL group: Alistipes shahii and Dialister pneumosintes were both ↑, and not found in the AL group |
Notably, 4 out of 7 cases of AL were from right-sided anastomosis |
| Lohsiriwat et al. [42] | Colon or rectal resection, or colectomy | Enterococcus, Pseudomonas and Klebsiella spp. | Of 55 cultures from AL patients; 51 cultures showed 1 or more bacteria | - |
| Mima et al. [43] | Colon or rectal resection | Increased risk of AL with increased amounts of Bifidobacterium (OR 3.96, 95% CI 1.50–10.51) | Association between Fusobacterium nucleatum, E. coli, or E. faecalis with AL was not significant | - |
| Palmisano et al. [44] | Colon or rectal resection | No |
AL-patients: Acinetobacter lwoffii and Acinetobacter johnsonii present (absent in non-AL patients) Hafnia alvei ↑, Faecalibacterium prausnitzii ↓ Non-AL patients: Barnesiella intestinihominis present (absent in AL patients) |
Three species (Anaerostipes caccae, Clostridium clariflavum, and Roseburia inulinivorans) were found in males, but practically absent in females |
| Reuvers et al. [45] | Colon or rectal resection | No | Infectious complications were reduced with Proteobacteria ↓ | |
| Sparreboom et al. [46] | Rectal resection | No difference in E. coli or E. faecalis levels on POD1-3 in drainage fluid among AL vs. non-AL patients | - | AL with or without diverting ileostomy (11.4% vs. 14.9%; p = 0.371) |
| Tominaga et al. [47] | Colon or rectal resection |
Occult leakage: P. aeruginosa (28.6%), E. faecalis (42.9%) Culture-positive: Enterobacter cloacae (11.3%) |
Occult leakage: Enterobacter cloacae (50%) Culture-positive: P. aeruginosa (21.0%), E. faecalis (19.4%) |
Drain fluid on POD6 was used for Gram staining (GS) and culture GS-positive patients had a pelvic CT-scan |
| van Praagh et al. [48] | Colon or rectal resection | No |
AL vs. non-AL group: Lachnospiraceae (40% vs. 27%; p = 0.010), Bacteroidaceae (28% vs. 17%; p = 0.008), and Blautia obeum (7% vs. 3%; p = 0.005) Presence of Prevotella copri, Streptococcus genus, and Eubacterium biforme was associated with a reduced risk of AL |
The study presented a model for the prediction of AL, based on levels of Lachnospiraceae, Bacteroidaceae, and Simpson diversity score |
AL anastomotic leakage, CDI Clostridioides difficile, OR odds ratio, CI confidence interval, POD postoperative day, RR relative risk