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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doi.org/10.1007/s00384-013-1776-8, hdl.handle.net/1765/71382
International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery
Department of Surgery

Komen, N.A.P, Slieker, J.C, Willemsen, P, Mannaerts, G.H.H, Pattyn, P, Karsten, T.M, … Lange, J.F. (2014). 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. International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery, 29(1), 15–21. doi:10.1007/s00384-013-1776-8