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

Niels Komen, J Slieker, P Willemsen, G Mannaerts, P Pattyn, T Karsten, JHW (Johannes) de Wilt, E (Erwin) van der Harst, Willem Leeuwen, C Decaestecker, J (Hans) Jeekel, Johan Lange

Research output: Contribution to journalArticleAcademicpeer-review

30 Citations (Scopus)


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. 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. 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 in significantly 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. Quantitative PCR for E. faecalis performed on drain fluid may be an objective, affordable and fast screening tool for symptomatic colorectal anastomotic leakage.
Original languageUndefined/Unknown
Pages (from-to)15-21
Number of pages7
JournalInternational Journal of Colorectal Disease
Issue number1
Publication statusPublished - 2014

Research programs

  • EMC ONWAR-01-94-01
  • EMC OR-02-47-12

Cite this