title: Polymerase chain reaction for Enterococcus faecalis in drain fluid: the first screening test for symptomatic colorectal anastomotic leakage. The Appeal-study: analysis of parameters predictive for evident anastomotic leakage.
abstract: OBJECTIVE
  With current diagnostic methods, the majority of patients with symptomatic colorectal anastomotic leakage(CAL) is identified approximately 1 week after operation.The aim of this study is to determine whether real-time polymerase chain reaction (RT-PCR) for detection of Escherichia coli and Enterococcus faecalis on drain fluid can serve as a screening test for CAL in the early postoperative phase.
  
  
  METHODS
  All patients included in this multicenter prospective observational study underwent left-sided colorectal resection for both malignant and benign diseases with construction of an anastomosis. In all patients, an intra-abdominal drain was placed during operation. During the first five postoperative days, drain fluid was processed for RT-PCR. The quantitative results of the RT-PCR on days 2 to 5 were compared to the results of day 1 in order to detect concentration changes.
  
  
  RESULTS
  In total, 243 patients, with both benign and malignant diseases, were included of whom 19 (7.8 %) developed symptomatic CAL. An increase in E. coli concentration was found insignificantly more patients with CAL on day 4 and 5 [p =0.0004; diagnostic odds ratio (DOR) 7.9]. For E. faecalis, this result was found for days 2, 3, and 4 (p <0.003) with highest DOR on day 3 (31.6). Sensitivity and negative predictive values were 92.9 and 98.7 %, respectively, virtually ruling out CAL in case of negative test results on the third postoperative day.
  
  
  CONCLUSIONS
  Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.
authors.forename: Niels
authors.initials: N
authors.lastname: Komen
authors.forename: Juliette
authors.initials: J
authors.lastname: Slieker
authors.forename: Paul
authors.initials: P
authors.lastname: Willemsen
authors.forename: Guido
authors.initials: G
authors.lastname: Mannaerts
authors.forename: Piet
authors.initials: P
authors.lastname: Pattyn
authors.forename: Tom
authors.initials: T
authors.lastname: Karsten
authors.forename: Hans
authors.initials: H
authors.lastname: de Wilt
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
authors.forename: Willem
authors.initials: W
authors.lastname: van Leeuwen
authors.forename: Christine
authors.initials: C
authors.lastname: Decaestecker
authors.forename: Hans
authors.initials: H
authors.lastname: Jeekel
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D057868:Anastomotic Leak / Q000175:diagnosis* / Q000382:microbiology*; D004322:Drainage; D013293:Enterococcus faecalis / Q000235:genetics* / Q000254:growth & development; D004926:Escherichia coli / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*