title: Bacteria: a major pathogenic factor for anastomotic insufficiency.
abstract: The aim of this study was to determine the influence of bacteria on the development of anastomotic insufficiency following gastrectomy in the rat. Fifty-seven male Wistar rats were randomly assigned to three groups and subjected to gastrectomy. Group I (n = 20) was orally inoculated with 10(9) Pseudomonas aeroginosa organisms on postoperative day 1. Group II (n = 20) served as the control group. Group III (n = 17) was decontaminated with 320 mg of tobramycin, 400 mg of polymyxin B, and 500 mg of vancomycin per liter of fluid administered from preoperative day 7 to postoperative day 10. Swabs from the oropharynx and rectum were cultured and analyzed daily for gram-positive and gram-negative bacteria. Surviving animals were sacrificed on postoperative day 10. All animals were autopsied immediately following death. Anastomotic insufficiency was defined as a histologically proven transmural defect at the suture line. Along with an effective reduction of pathogenic bacteria colonizing the oropharynx, the rate of anastomotic insufficiency could be reduced significantly, to 6% in decontaminated animals compared with 80% in controls (P < 0.001 by Fisher's exact test). Inoculation of group I animals with P. aeruginosa led to an increase of anastomotic insufficiency up to 95% and a significant increase in mortality (P < 0.05). We conclude that bacteria play a major role in the pathogenesis of anastomotic insufficiency following gastrectomy in the rat.
authors.affiliation: Department of Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: H M
authors.initials: HM
authors.lastname: Schardey
authors.forename: T
authors.initials: T
authors.lastname: Kamps
authors.forename: H G
authors.initials: HG
authors.lastname: Rau
authors.forename: S
authors.initials: S
authors.lastname: Gatermann
authors.forename: G
authors.initials: G
authors.lastname: Baretton
authors.forename: F W
authors.initials: FW
authors.lastname: Schildberg
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001424:Bacterial Infections / Q000517:prevention & control*; D015169:Colony Count, Microbial; D008297:Male; D011113:Polymyxins / Q000494:pharmacology*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013270:Stomach / Q000601:surgery*; D014031:Tobramycin / Q000494:pharmacology*; D014640:Vancomycin / Q000494:pharmacology*
chemical_list: D011113:Polymyxins; D014640:Vancomycin; D014031:Tobramycin