Purpose

Some gut bacteria can produce enzymes (collagenases) that can break down collagen in the intestinal wall. This could be a part of the pathophysiology of anastomotic leakage (AL). This systematic review aimed to investigate if such bacteria were present more frequently in AL patients versus non-AL patients following colorectal surgery.

Methods

This systematic review was reported according to the PRISMA and AMSTAR guidelines. Before the literature search, a study protocol was registered at PROSPERO (CRD42022363454). We searched PubMed, EMBASE, Google Scholar, and Cochrane CENTRAL on April 9^th, 2023, for randomized and observational human studies of AL following colorectal surgery with information on gastrointestinal bacteria. The primary outcome was bacteria with the potential to produce collagenase. The risk of bias was assessed with the Newcastle–Ottawa Scale, as all studies were observational.

Results

We included 15 studies, with a total of 52,945 patients, of which 1,747 had AL, and bacteriological information from feces, mucosa, the resected specimen, or drain fluid was presented. In 10 of the 15 studies, one or more collagenase-producing bacteria were identified in the patients with AL. Neither the bacteria nor the collagenase production were quantified in any of the studies. The studies varied greatly in terms of sample material, analytical method, and time of collection. Studies using DNA sequencing methods did not report findings of collagenase-producing bacteria.

Conclusion

Collagenase-producing bacteria are more common in patients with AL following colorectal surgery than in patients without AL, but the significance is unclear. From the current studies, it is not possible to determine the pathogenicity of the individual gut bacteria.

中文翻译：

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产生胶原酶的细菌在结直肠手术后吻合口瘘中很常见：系统评价

目的

一些肠道细菌可以产生酶（胶原酶），可以分解肠壁中的胶原蛋白。这可能是吻合口漏 (AL) 病理生理学的一部分。本系统综述旨在调查结直肠手术后 AL 患者与非 AL 患者相比，此类细菌是否更频繁地出现。

方法

本系统评价是根据 PRISMA 和 AMSTAR 指南进行报告的。在文献检索之前，研究方案已在 PROSPERO 注册（CRD42022363454）。^{我们于 2023 年 4 月 9日}检索了 PubMed、EMBASE、Google Scholar 和 Cochrane CENTRAL ，以查找结直肠手术后 AL 的随机和观察性人体研究，以及有关胃肠道细菌的信息。主要结果是具有产生胶原酶潜力的细菌。由于所有研究都是观察性的，因此使用纽卡斯尔-渥太华量表评估偏倚风险。

结果

我们纳入了 15 项研究，总共 52,945 名患者，其中 1,747 名患者患有 AL，并提供了来自粪便、粘膜、切除标本或引流液的细菌学信息。在这 15 项研究中，有 10 项在 AL 患者体内鉴定出一种或多种产生胶原酶的细菌。在任何研究中都没有对细菌和胶原酶的产生进行量化。这些研究在样本材料、分析方法和收集时间方面差异很大。使用 DNA 测序方法的研究并未报告产生胶原酶的细菌的发现。

结论

结直肠手术后 AL 患者中产生胶原酶的细菌比非 AL 患者更常见，但其意义尚不清楚。从目前的研究来看，不可能确定单个肠道细菌的致病性。