Abstract
BackgroundColon surgery has been shown to modulate the intestinal microbiota. Our objective was to characterize these changes using state-of-the-art next generation sequencing techniques.MethodsWe performed a single-centre prospective observational cohort study to evaluate the changes in the gut microbiota, i.e., taxon distribution, before and after elective oncologic colon surgery in adult patients with different antimicrobial prophylaxis regimens (standard prophylaxis with cefuroxime/metronidazole versus carbapenems for extended-spectrum beta-lactamase-producing Enterobacterales [ESBL-E] carriers). We obtained rectal samples on the day of surgery, intraoperative luminal samples, and rectal or stoma samples 3 days after surgery. We performed metataxonomic analysis based on sequencing of the bacterial 16S rRNA gene marker. Similarities and differences between bacterial communities were assessed using Bray–Curtis similarity, visualised using principal coordinates analysis and statistically tested by PERMANOVA. Comparison of taxa relative abundance was performed using ANCOM.ResultsWe included 27 patients between March 27, 2019 and September 17, 2019. The median age was 63.6 years (IQR 56.4–76.3) and 44% were females. Most (81%) patients received standard perioperative prophylaxis as they were not ESBL carriers. There was no significant association between ESBL carriage and differences in gut microbiome. We observed large and significant increases in the genus Enterococcus between the preoperative/intraoperative samples and the postoperative sample, mainly driven by Enterococcus faecalis. There were significant differences in the postoperative microbiome between patients who received standard prophylaxis and carbapenems, specifically in the family Erysipelotrichaceae.ConclusionThis hypothesis-generating study showed rapid changes in the rectal microbiota following colon cancer surgery.
Highlights
Surgical site infections (SSI) are a leading cause of healthcare-associated infections [1]
One patient was excluded because the postoperative sample was not collected, leaving 27 patients in the final analysis
One patient was operated for a non-resectable polyp, two were operated for neuroendocrine tumours, and the remaining 24 patients had adenocarcinoma
Summary
Surgical site infections (SSI) are a leading cause of healthcare-associated infections [1]. Patient-level risk factors for SSI in colorectal surgery include age [4, 5], obesity [5,6,7,8], and diabetes [4]. The current paradigm surrounding management of the high bacterial load prior to surgery is to maximise decontamination, either by perioperative antibiotic prophylaxis alone (one of the most effective measures) or in combination with bowel cleansing (mechanical bowel preparation) and/or topical oral antibiotics [13]. This decontamination indiscriminately affects both beneficial and potentially pathogenic bacteria. Our objective was to characterize these changes using state-of-the-art generation sequencing techniques
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