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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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage (CAL) is identified approximately 1 week after operation. The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase.

Methods

All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes.

Results

In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found in significantly more patients with CAL on day 4 and 5 [p = 0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p < 0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day.

Conclusion

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

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Acknowledgments

The authors are grateful to all coworkers in the Departments of Surgery and Microbiology of the following hospitals: ZNA Middelheim, Antwerp, Belgium; Sint Franciscus Gasthuis, Rotterdam, The Netherlands; Erasmus MC, Rotterdam, The Netherlands; Reinier de Graaf Gasthuis, Delft, The Netherlands; University Hospital of Ghent, Ghent, Belgium; Daniel Den Hoed Kliniek, Erasmus MC, Rotterdam, The Netherlands; and Maasstad Ziekenhuis Rotterdam, Rotterdam, The Netherlands. This research was made possible by grant from “Stichting Technische Wetenschappen”, Utrecht, The Netherlands.

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Authors and Affiliations

  1. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

    Niels Komen, Juliette Slieker, Hans de Wilt, Hans Jeekel & Johan F. Lange

  2. Department of Surgery, ZNA Middelheim, Antwerp, Belgium

    Paul Willemsen

  3. Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands

    Guido Mannaerts

  4. Department of Surgery, University Hospital Ghent, Ghent, Belgium

    Piet Pattyn

  5. Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands

    Tom Karsten

  6. Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Hans de Wilt

  7. Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands

    Erwin van der Harst

  8. Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    Willem van Leeuwen

  9. Laboratory of Image Synthesis and Analysis (LISA), Ecole polytechnique de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Christine Decaestecker

  10. Department of Surgery, GZA Sint Augustinus, Oosterveldlaan 24, 2610, Wilrijk, Belgium

    Niels Komen

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  1. Niels Komen
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Correspondence to Niels Komen.

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Komen, N., Slieker, J., Willemsen, P. et al. 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. Int J Colorectal Dis 29, 15–21 (2014). https://doi.org/10.1007/s00384-013-1776-8

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  • DOI: https://doi.org/10.1007/s00384-013-1776-8

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