Are gut bacteria associated with the development of anastomotic leaks? A review of experimental and clinical studies

It has been proven in experimental and clinical studies that combined perioperative systemic antibiotic prophylaxis and prolonged nonresorbable topical antibiotics directed against common intestinal Gram-negative and Gram-positive pathogens in a mechanically cleaned bowel are effective in preventing intestinal anastomotic leak (AL). For 60 years, evidence has been accumulating that AL is caused by microbial pathogenicity. Examples are E. faecalis and P. aeruginosa, which develop the ability to breakdown collagen and/or cleave host Matrix metalloproteinase 9 (MMP9). The surgical trauma seems to trigger such complex reactions as gentotypical and phenotypical changes in commensal microbiota, turning them into tissue-destroying, leak-inducing pathogens. Investigations of further molecular mechanisms and clinical studies are ongoing. The use of antibiotics disrupts the endogenous microbiome and causes antibiotic resistance. It is therefore important to find therapies that leave the microbiome intact and target microbial virulence expression. One such approach to avoid indiscriminate elimination of all potential pathogens with simultaneous damage to protective microbiota is represented by phosphate-loaded polyethylene glycopolymers.