Department of Surgery, University of Chicago, Chicago, Illinois.
Colon and Rectal Surgery Associates, University of Minnesota, Minneapolis, Minnesota.
Dis Colon Rectum. 2019 Aug;62(8):972-979. doi: 10.1097/DCR.0000000000001417.
Bacteria that produce collagen-digesting enzymes (collagenolytic bacteria) have been shown to play a critical and previously unappreciated role in anastomotic leak pathogenesis by breaking down host tissue extracellular matrix proteins. Detection of these bacteria is labor intensive, and no screening method currently exists.
We evaluated a rapid screening method developed to detect the presence of these collagenolytic bacteria in clinical samples, such as drain fluid, anastomotic tissue, or feces.
We compared a new method of detecting collagenolytic bacterial species with a previously used technique using samples from a murine experimental model and then demonstrated the utility of this screening method in samples from patients with anastomotic complications.
All of the laboratory work and previous murine experiments were performed in Dr Alverdy's laboratory at the University of Chicago under institutional review board-approved protocols.
Samples from patients with challenging wound complications were provided by participating clinicians with verbal patient consent. Given the small number of patients, this was determined to be institutional review board exempt.
Whether this analysis can influence patient management and outcomes will require additional study.
This screening method detects numerous strains of bacteria with collagenolytic properties, including the collagenolytic species that have been implicated previously in anastomotic leak. Once collagenolytic strains are identified, they can be speciated and tested for antibiotic resistance using standard laboratory techniques.
This study is limited by the small number of patient samples tested.
We demonstrated the potential applicability of this assay to evaluate rare and complex anastomotic complications that often require analysis beyond standard culture and sensitivity assays. Future applications of this method may allow the development of strategies to prevent anastomotic leak related to collagenolytic bacteria. See Video Abstract at http://links.lww.com/DCR/A962.
已证实，产生胶原分解酶的细菌（胶原溶菌菌）通过分解宿主组织细胞外基质蛋白，在吻合口漏发病机制中发挥关键且以前未被重视的作用。这些细菌的检测既费力又耗时，目前尚无筛选方法。
我们评估了一种快速筛选方法，旨在检测临床样本（如引流液、吻合组织或粪便）中这些胶原溶菌菌的存在。
我们比较了一种新的检测胶原溶菌细菌的方法和以前使用的技术，方法是使用来自鼠实验模型的样本，然后证明了这种筛选方法在吻合口并发症患者样本中的实用性。
所有实验室工作和以前的鼠实验都是在芝加哥大学 Alverdy 博士的实验室中进行的，符合机构审查委员会批准的方案。
有挑战性伤口并发症的患者样本由参与的临床医生提供，并获得了患者的口头同意。鉴于患者人数较少，这被确定为机构审查委员会豁免。
这种分析是否能影响患者的管理和结果需要进一步研究。
这种筛选方法可检测具有胶原分解特性的多种细菌菌株，包括以前与吻合口漏相关的胶原分解物种。一旦鉴定出胶原溶菌菌，就可以使用标准实验室技术对其进行分类并测试其抗生素耐药性。
本研究受到测试的患者样本数量较少的限制。
我们证明了该检测方法在评估罕见和复杂吻合口并发症方面的潜在适用性，这些并发症通常需要超出标准培养和药敏检测的分析。该方法的未来应用可能有助于制定预防与胶原溶菌菌相关的吻合口漏的策略。详见视频摘要，网址：http://links.lww.com/DCR/A962。
