To Leak or Not to Leak: Is Enterococcus the Answer to The Question?

Author(s):
Mikayla Moody; Robert Sawyer; Tjasa Hranjec

Background:

Pseudomonas and Enterococcus species have been associated with anastomotic leaks in animal experiments.

Hypothesis:

We hypothesized that these bacteria would contribute to anastomotic breakdown following intra-abdominal operations as well.

Methods:

Adult patients treated between 1997 and 2023 with peritoneal infection after an intra-abdominal operation were evaluated retrospectively. Infections were classified as due to or not due to anastomotic leak based on clinical findings.  Univariate analysis evaluated demographic and infection data, while risk factors for anastomotic leak and patient mortality were evaluated via multivariate analysis.

Results:

713 patients with post-operative intra-abdominal infections were identified, 267 (37.4%) with anastomotic leak. Patients with anastomotic leak were more likely to be admitted to the intensive care unit and have prolonged hospital stay, despite earlier initiation of antibiotics.     The most commonly isolated organisms, Pseudomonas, Enterococcus and Candida spp were not independently associated with an increased risk of anastomotic leak.  APACHEII score, increasing age and need for transfusion were the most important predictors of mortality.  While Candida spp were associated with an increased mortality, Enterococcus and Pseudomonas spp were not.

Conclusions:

Neither Pseudomonas nor Enterococcus infection were associated with anastomotic leak. The main predictor was treatment with immunosuppressants. Further analysis is needed to assess the relationship between enterococci and anastomotic leak.