title: Microbiological analysis of fluids in postsurgical gastroesophageal intrathoracic leaks obtained by endoscopy: a new way to optimize antibiotic therapy.
abstract: OBJECTIVE
  Postsurgical gastroesophageal intrathoracic leakage is a potentially life-threatening condition that is frequently accompanied by mediastinitis and subsequent sepsis. Aspiration of fluids from intrathoracic leaks during endoscopy for microbiological analysis is rarely performed in clinical routine. The aim was to evaluate the role of routine microbiological analysis of intrathoracic leaks via endoscopy and its impact on antibiotic therapy.
  
  
  METHODS
  This is a prospective, observational single-center study. Seventeen consecutive patients who presented for endoscopic treatment of intrathoracic leaks were included. Concomitantly, fluids from intrathoracic leaks during endoscopic intervention and blood cultures were obtained and a microbiological analysis was performed.
  
  
  RESULTS
  Bacteria and/or fungi were detected by culture of fluid aspirated from intrathoracic leaks in 88% cases, but in none of the blood cultures. In 15 patients, microbial colonization of the leakage was detected despite previous empiric antibiotic therapy; treatment had to be adjusted in all patients according to the observed antibiotic susceptibility profile.
  
  
  CONCLUSIONS
  The microbiological colonization of postsurgical gastroesophageal intrathoracic leaks in patients is frequent. Only the direct microbiological analysis of fluids from intrathoracic leaks, but not of blood cultures, is effective for optimizing an antibiotic therapy in such patients.
authors: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
authors: Thomas J
authors: TJ
authors: Erichsen
authors: Ralf-Peter
authors: RP
authors: Vonberg
authors: Henrike
authors: H
authors: Lenzen
authors: Ahmed A
authors: AA
authors: Negm
authors: Fabian A
authors: FA
authors: Helfritz
authors: Nikos
authors: N
authors: Emmanouilidis
authors: Michael P
authors: MP
authors: Manns
authors: J
authors: J
authors: Wedemeyer
authors: Sebastian
authors: S
authors: Suerbaum
authors: Tim O
authors: TO
authors: Lankisch
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000382:microbiology* / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001826:Body Fluids / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal; D016629:Esophagectomy / Q000009:adverse effects; D004947:Esophagus / Q000601:surgery*; D005122:Exudates and Transudates / Q000382:microbiology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009780:Occult Blood; D011446:Prospective Studies; D013270:Stomach / Q000601:surgery*; D035423:Thoracic Cavity / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents