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. 2025 Aug 6:22:100302.
doi: 10.1016/j.sipas.2025.100302. eCollection 2025 Sep.

The influence of antibiotic and mechanical bowel preparation on the microbiome in colorectal cancer surgery: A pilot study

Undine Gabriele Lange  1 , Konrad Lehr  2 , René Thieme  1 , Albrecht Hoffmeister  3 , Jürgen Feisthammel  3 , Ines Gockel  4 , Alexander Link  2 , Boris Jansen-Winkeln  5
Affiliations

The influence of antibiotic and mechanical bowel preparation on the microbiome in colorectal cancer surgery: A pilot study

Undine Gabriele Lange et al. Surg Pract Sci. .

Abstract

Backround: The extent to which bowel preparation mechanical (MBP) or oral antibiotic (OA) or in combination (MBP/OA)) should be performed prior to elective colorectal surgery is the subject of ongoing debate. The aim of our study was to investigate the effect of MPB/OA [with single-shot intravenous antibiotic administration before incision (MPB/OA+ivAB)] on the microbiome of patients with colorectal carcinoma (CRC) operated minimally-invasive.

Methods: We were studying 16 consecutive patients who underwent elective resection surgery for CRC at our centre in a prospective panel study. MBP was performed and 1 g parmomomycin/500 mg metronidazole was administered orally one day preoperatively; 1 g ertapenem was administered intravenously 30 min prior incision. Three mucosal samples were taken preoperatively during colonoscopy and intraoperatively and analysed by 16S rRNA V1-V2 gene sequencing.

Results: Before MPB/OA+ivOA, the genera Phocaeicola (10 %), Bacteroides (7 %) and unclassified Ruminococcaceae (6 %) were predominant. After preparation, all bacteria were reduced except Enterococcus (7 %) and Escherichia/Shigella (6 %), which had increased. Significant reductions were seen for Bacteroides (p = 0.01), Haemophilus (p = 0.047), Holdemanella (p = 0.004), Neisseria (p = 0.004), Odoribacter (p = 0.027), unclassified Clostridiales (p = 0.008) and unclassified Ruminococcacaeae (p = 0.009). Large effect sizes (Cohens'd) were seen for Bacteroidetes (d = 0.864) and unclassified Ruminococcacaeae (d = 0.909).

Conclusions: In our pilot study, we observed a significant reduction in seven bacterial genera after MBP/OA+ivAB in patients with CRC. Some of these bacterial genera have been associated with anastomotic insufficiency. Further, large in-depth analyses are needed to evaluate perioperative microbial drift with postoperative complications.

Keywords: Bowel preparation; Colorectal surgery; Gut microbiome; Preoperative oral antibiotics.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Alexander Link reports financial support was provided by German Federal Ministry of Education and Research (BMBF). Alexander Link reports was provided by European Regional Development Fund. Alexander Link reports financial support was provided by Janssen Pharmaceuticals Inc. Alexander Link reports financial support was provided by Ferring Pharmaceuticals Inc. Alexander Link reports financial support was provided by LUVO Medical Technologies Inc. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1:
Fig. 1
Mean distribution of abundant genera in mucosal samples before and after MBP/OA±ivOA Distribution of abundant genera in patient mucosal samples at the two time-points (PreSURG and SURG).
Fig 2:
Fig. 2
Boxplots of relative abundances PRESURG/SURG (a-g) Boxplots showing relative abundance of Bacteroides, Haemophilus, Holdemanella, Neisseria, Odoribacter, unclassified Clostriales and unclassified Ruminococcus at the time-points before (PreSURG) and during surgery (SUR) in mucosal samples.
See this image and copyright information in PMC

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