Zennami Kenji, Nukaya Takuhisa, Ishikawa Kiyohito, Tomozawa Shuhei, Kawai Akihiro, Nakamura Wataru, Muto Yoshinari, Saruta Masanobu, Motonaga Tomonari, Takenaka Masashi, Takahara Kiyoshi, Kusaka Mamoru, Sumitomo Makoto, Shiroki Ryoichi
Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
Department of Urology, Nagoya University Graduate School of Medicine, 65 Tsuruma-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
Sci Rep. 2025 Jul 1;15(1):22333. doi: 10.1038/s41598-025-07932-4.
The composition of the distal ileum microbiota and the impact of fecal exposure during intracorporeal urinary diversion (ICUD) on gastrointestinal (GI) complications remain unclear. This study included 146 patients with bladder cancer who underwent ICUD without bowel preparation and received only a single day of antibiotic prophylaxis. Fecal samples were collected directly from the distal ileum during surgery, and ascitic fluid was obtained postoperatively from abdominal drains. Among the patients, 129 (88.3%) had minimal microbial growth in ileal feces, while 17 (11.7%) showed significant colonization. The most commonly identified organisms were Streptococcus, Enterococcus, Enterobacter, Klebsiella, and Candida. The incidence of GI complications was significantly higher in patients with positive ileal fecal cultures compared to those with no detectable growth (39.4% vs. 7.7%, P < 0.001), and even more pronounced in patients with positive ascitic cultures (72.5% vs. 11.3%, P < 0.001). Multivariate analysis identified positive ascitic cultures as an independent predictor of GI complications. Additionally, frailty was significantly associated with the presence of microbial growth in ascitic fluid. These findings suggest that, although the distal ileal microbiota is largely suppressed under short-term antibiotic prophylaxis, the presence of intra-abdominal bacteria or fungi is strongly linked to postoperative GI complications, including ileus. Frailty may contribute to microbial dysbiosis and the persistence of intra-abdominal pathogens, particularly Enterococcus and Enterobacter species.
回肠末端微生物群的组成以及体内尿流改道（ICUD）期间粪便暴露对胃肠道（GI）并发症的影响仍不清楚。本研究纳入了146例接受ICUD且未进行肠道准备、仅接受单日抗生素预防的膀胱癌患者。手术期间直接从回肠末端采集粪便样本，术后从腹腔引流管获取腹水样本。在这些患者中，129例（88.3%）回肠粪便中的微生物生长极少，而17例（11.7%）显示有显著定植。最常鉴定出的微生物为链球菌、肠球菌、肠杆菌、克雷伯菌和念珠菌。回肠粪便培养阳性的患者胃肠道并发症的发生率显著高于未检测到微生物生长的患者（39.4%对7.7%，P < 0.001），在腹水培养阳性的患者中更为明显（72.5%对11.3%，P < 0.001）。多变量分析确定腹水培养阳性是胃肠道并发症的独立预测因素。此外，虚弱与腹水中微生物生长的存在显著相关。这些发现表明，尽管在短期抗生素预防下，回肠末端微生物群在很大程度上受到抑制，但腹腔内细菌或真菌的存在与术后胃肠道并发症（包括肠梗阻）密切相关。虚弱可能导致微生物失调以及腹腔内病原体（特别是肠球菌和肠杆菌属）的持续存在。
