Gut Proteobacteria levels and colorectal surgical infections: SELECT trial
J. Reinder D. Reuvers, Andries E. Budding, Marjolein van Egmond, Hein B.A.C. Stockmann, Jos W. R. Twisk, Geert Kazemier, G.S.A. Abis, Steven J. Oosterling, SELECT trial group, G.S.A. Abis, H. Jaap Bonjer, Jurriaan B. Tuynman, Marjolein van Egmond, Hein B.A.C. Stockmann, N. de Korte, Yaïr I. Z. Acherman, Steven J. Oosterling, Frank C. den Boer, D J A Sonneveld, Andries E. Budding, Linda Poort
Abstract
Infectious complications and anastomotic leakage after colorectal resection are common1–3, impede postoperative recovery, and influence oncological outcome4. The patient’s gut microbiota has a critical role in metabolic function, protection against pathogens, and modulation of immune function5. In addition, the microbiota plays a pivotal role in the development of infectious complications after gastrointestinal surgery6,7. One phylum which normally represents less than 10 per cent of the bacteria in the gut is Proteobacteria8. During the perioperative phase, the gut microbiota composition is disturbed by various factors, including surgery itself, mechanical bowel preparation, and antibiotics1,9–11. These disturbances cause dysbiosis, which can lead to overgrowth of normally low-abundant pathogenic species, such as Proteobacteria12. Clinical studies in humans elucidating the role of this phylum in postoperative infectious complications remain scarce. The randomized SELECT trial showed a reduction in postoperative infectious complications after elective colorectal surgery with selective decontamination of the digestive tract (SDD) as oral antibiotic prophylaxis1. SDD was administered to reduce the pathogenic bacterial load, including Proteobacteria, in the gut. This study, a subgroup analysis of patients who participated in the SELECT trial, aimed to determine the role of preoperative proteobacterial load in the gut in postoperative infectious complications.