Related Experiment Video
Updated: May 23, 2025
09:40
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
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Microbial Pathogen Spectrum in Anastomotic Leaks after Ivor-Lewis Esophagectomy
Andreas Schneider1,2, Seung-Hun Chon3, Philipp Kasper4
1Department of Anesthesiology and Intensive Care Medicine, Kliniken Maria Hilf, Mönchengladbach, Germany.
Surgical Infections
|March 10, 2025
Summary
Anastomotic leaks after esophagectomy involve diverse bacteria and yeasts. Effective empiric antibiotic therapy requires considering enterobacterales, enterococci, and yeasts, with piperacillin-tazobactam, meropenem, or tigecycline showing low failure rates.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Infectious Diseases
Background:
- Anastomotic leaks following esophagectomy are serious complications.
- Effective antimicrobial therapy is crucial for managing these leaks.
Purpose of the Study:
- To investigate the microbial pathogen spectrum in anastomotic leaks after esophagectomy.
- To inform optimal empiric antimicrobial treatment strategies.
Main Methods:
- Retrospective analysis of patients who developed anastomotic leaks after Ivor-Lewis esophagectomy.
- Analysis of microbiological cultures from surgical samples, chest tube fluid, endoscopic aspirates, and blood cultures.
Main Results:
- Gram-positive bacteria (viridians streptococci, enterococci) and gram-negative bacteria (enterobacterales) were prevalent.
- Yeasts were also frequently detected (43%-64%).
- Low prevalence of multidrug-resistant bacteria; piperacillin-tazobactam, meropenem, and tigecycline showed <10% expected failure rates when combined with echinocandins.
Conclusions:
- Anastomotic leaks present a broad spectrum of microbial pathogens.
- Empiric antimicrobial choices should account for enterobacterales, enterococci, and yeasts.
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