eP493 - Increased Rates of Enterococcus Faecalis Colonization in Patients with Anastomotic Leak

Purpose/Background: Anastomotic leak is one of the most morbid complications following colorectal resections, leading to longer hospital stays, unplanned invasive procedures, and higher rates of mortality. Using a rodent model for resection and anastomosis, it has been shown that collagenase-producing bacteria, specifically Enterococcus faecalis, promotes anastomotic leak by deteriorating tissue at the anastomotic site. This finding has been associated with anastomitic leak in human patients as well, however only within a small population.Methods/Interventions: Using our internal infection control database, medical records of patients who underwent colon and/or rectal resection at 3 Northwell tertiary hospitals between 2019-2023 were queried for post operative intra-abdominal infection. Patients who developed anastomotic leak, stump leak, or abdominal deep space collection without associated anastomotic leak with available culture data were included.Results/Outcomes: 98 patients with post operative culture data were identified, 58% of which were males. The average age of this patient population was 66 years old. The most common indication for surgery was neoplasm (37%), followed by diverticulitis (25%), and IBD (6%). Of these patients, 52 developed an anastomotic leak, 10 developed a stump leak, and 36 developed a deep space infection. The majority of patients (62%) were managed with IR drainage, where 36% underwent reoperation and 2% had drains placed during the index operation. There was no stastistical difference in age, gender, or BMI between the patients who developed an anastomotic leak, stump leak, or deep space infection. As expected, the majority of anastomotic leaks were resultant of elective procedures (77%), wheras those who developed a stump leak or deep space infection had more frequently undergone emergency surgery, 70% and 58%, respectively (p < 0.001). Enterococcus faecalis was cultured in 24 (46%) of patients who developed anastomotic leak, compared to 3 (30%) of patients with stump leak and 8 (22%) of patients with deep space infection (p=0.02). Antimicrobial resistance was slightly increased in the cultures isolated from the anastomotic leak cohort (77%), compared to stump leak and deep space infection (70% and 69%, respectively).Conclusion/

Discussion: Enterococcus faecalis was more prevalent in post operative infections due to anastomotic leak compared to other deep space infections or stump leaks. This continues to support evidence that development of anastomotic leak may be driven by bacterial pathogenesis. Screening for and targeting these and other collagenase forming bacteria in the pre-operative setting may decrease rates of anastomotic leak.