{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T03:19:19Z","timestamp":1771903159087,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Postoperative pneumonia and other infectious complications after robotic-assisted minimally invasive esophagectomy still contribute to morbidity and mortality. Selective oral decontamination of the esophagus prior to surgery might reduce the rate of infectious complications. However, its impact on the esophageal microbiota is unknown. Therefore, this study aimed to analyze whether selective oral decontamination of the esophagus prior to surgery reduces postoperative pneumonia rates and alters the esophageal microbiome. Methods: We conducted a proof-of-principle study including 22 patients who underwent robotic-assisted minimally invasive esophagectomy. Thirteen patients were treated with 50 mg amphotericin B, 8 mg tobramycin, and 10 mg colistin orally 7 days prior to surgery, intraoperatively, and 5 days postoperatively. The remaining nine patients received standard-of-care treatment (no oral decontamination). The esophageal microbiome was assessed using 16S rRNA gene amplicon libraries which were annotated using the Ribosomal Data Project. The incidence of postoperative (at discharge from hospital or 30 days, whichever was later) infectious complications was assessed. Results: Selective oral decontamination was associated with reduced overall rates of infectious complications (7.7% vs. 55.5%, p = 0.008) and postoperative pneumonia (0% vs. 33.3%, p = 0.007). Alterations in the esophageal microbiome depending on selective oral decontamination were detectable. The microbiomes of patients with infectious complications showed higher abundances of Neisseria and lower abundances of Streptococcus than samples without infectious complications. Conclusions: Selective oral decontamination reduced the rate of postoperative complications, postoperative pneumonia in particular, after robot-assisted esophagectomy. Alterations in the microbiome were also evident following decontamination. Further studies with larger sample sizes are necessary to confirm these data.<\/jats:p>","DOI":"10.3390\/antibiotics14101033","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T11:57:42Z","timestamp":1760529462000},"page":"1033","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Selective Oral Decontamination of the Esophagus to Reduce Microbial Burden in Patients Undergoing Esophagectomy for Esophageal Cancer (SODA)\u2014First Results from a Proof-of-Principle Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7289-2891","authenticated-orcid":false,"given":"Johannes","family":"Klose","sequence":"first","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3213-8138","authenticated-orcid":false,"given":"Konrad","family":"Lehr","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1107-813X","authenticated-orcid":false,"given":"Ulrich","family":"Ronellenfitsch","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A.","family":"Klose","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-4748","authenticated-orcid":false,"given":"Daniel","family":"Ebert","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgical Intensive Care, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5267-079X","authenticated-orcid":false,"given":"Artur","family":"Rebelo","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9514-4562","authenticated-orcid":false,"given":"Alexander","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, 39120 Magdeburg, Germany"},{"name":"Department of Gastroenterology, Klinikum Bayreuth GmbH, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Medical Campus Upper Franconia, 95445 Bayreuth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3432-6669","authenticated-orcid":false,"given":"J\u00f6rg","family":"Kleeff","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"key":"ref_1","first-page":"336","article-title":"S3-Leitlinie\u2014Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des \u00d6sophagus","volume":"57","author":"Porschen","year":"2019","journal-title":"Z. Fur Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1007\/s11605-017-3572-1","article-title":"Transhiatal vs. Transthoracic Esophagectomy: A NSQIP Analysis of Postoperative Outcomes and Risk Factors for Morbidity","volume":"21","author":"Schlottmann","year":"2017","journal-title":"J. Gastrointest. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/SLA.0000000000002611","article-title":"Benchmarking Complications Associated with Esophagectomy","volume":"269","author":"Low","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1245\/s10434-014-4310-5","article-title":"Pattern of Postoperative Mortality After Esophageal Cancer Resection According to Center Volume: Results from a Large European Multicenter Study","volume":"22","author":"Markar","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.jtcvs.2010.08.038","article-title":"A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia","volume":"140","author":"Berry","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.ejso.2016.11.013","article-title":"Hospital costs of complications after esophagectomy for cancer","volume":"43","author":"Goense","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_7","first-page":"doaa039","article-title":"Anastomotic leakage after esophagectomy for esophageal cancer: Definitions, diagnostics, and treatment","volume":"34","author":"Fabbi","year":"2021","journal-title":"Dis. Esophagus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.athoracsur.2020.08.022","article-title":"Risk Factors and Consequences of Anastomotic Leakage After Esophagectomy for Cancer","volume":"112","author":"Hagens","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3748\/wjg.v25.i3.356","article-title":"Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks","volume":"25","author":"Fumagalli","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1200\/JCO.2011.40.3568","article-title":"Influence of major postoperative complications on health-related quality of life among long-term survivors of esophageal cancer surgery","volume":"30","author":"Derogar","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.jtcvs.2015.04.030","article-title":"Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence","volume":"150","author":"Kofoed","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/nrgastro.2016.139","article-title":"The gut microbiota and gastrointestinal surgery","volume":"14","author":"Guyton","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"104011","DOI":"10.1016\/j.ebiom.2022.104011","article-title":"Gut microbial similarity in twins is driven by shared environment and aging","volume":"79","author":"Skieceviciene","year":"2022","journal-title":"EBioMedicine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"doac086","DOI":"10.1093\/dote\/doac086","article-title":"The association between postoperative complications and long-term survival after esophagectomy: A multicenter cohort study","volume":"36","author":"Fransen","year":"2023","journal-title":"Dis. Esophagus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1245\/s10434-024-16364-9","article-title":"The Current State of Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry","volume":"32","author":"Kooij","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e386","DOI":"10.1097\/SLA.0000000000004550","article-title":"Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Results From the Multicenter International Registry","volume":"276","author":"Kingma","year":"2022","journal-title":"Ann Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.ejso.2021.11.121","article-title":"Robot-assisted and conventional minimally invasive esophagectomy are associated with better postoperative results compared to hybrid and open transthoracic esophagectomy","volume":"48","author":"Babic","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1002\/bjs.9254","article-title":"Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery","volume":"100","author":"Roos","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1007\/s11605-023-05746-1","article-title":"Selective Decontamination with Oral Antibiotics in Colorectal Surgery: 90-day Reintervention Rates and Long-Term Oncological Follow-Up","volume":"27","author":"Scholten","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Janssen, R., Van Workum, F., Baranov, N., Blok, H., Oever, J.T., Kolwijck, E., Tostmann, A., Rosman, C., and Schouten, J. (2021). Selective Decontamination of the Digestive Tract to Prevent Postoperative Pneumonia and Anastomotic Leakage after Esophagectomy: A Retrospective Cohort Study. Antibiotics, 10.","DOI":"10.3390\/antibiotics10010043"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s00104-021-01550-2","article-title":"Strategiewechsel zur minimal-invasiven \u00d6sophagektomie\u2014Ergebnisse an einem zertifizierten Zentrum","volume":"93","author":"Merboth","year":"2022","journal-title":"Die Chir."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/1471-2482-10-36","article-title":"Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection","volume":"10","author":"Warschkow","year":"2010","journal-title":"BMC Surg."},{"key":"ref_23","first-page":"2049","article-title":"[Optimizing antibiotics policy in the Netherlands. V. SWAB guidelines for perioperative antibiotic prophylaxis. Foundation Antibiotics Policy Team]","volume":"144","author":"Gyssens","year":"2000","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_24","first-page":"144","article-title":"Effects of selective decontamination of digestive tract on mortality and antibiotic resistance in the intensive-care unit","volume":"11","year":"2005","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1056\/NEJMoa0800394","article-title":"Decontamination of the digestive tract and oropharynx in ICU patients","volume":"360","author":"Kluytmans","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e002529","DOI":"10.1136\/bmjopen-2012-002529","article-title":"Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: A cost-effectiveness analysis","volume":"3","author":"Oostdijk","year":"2013","journal-title":"BMJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/0140-6736(90)90813-K","article-title":"Selective decontamination to reduce gram-negative colonisation and infections after oesophageal resection","volume":"335","author":"Tetteroo","year":"1990","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1159\/000375300","article-title":"Microbiological analysis of fluids in postsurgical gastroesophageal intrathoracic leaks obtained by endoscopy: A new way to optimize antibiotic therapy","volume":"91","author":"Erichsen","year":"2015","journal-title":"Digestion"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s00423-025-03709-5","article-title":"Patterns of infectious complications and their implication on health system costs after esophagectomy for esophageal cancer: Real-world data from three European centers","volume":"410","author":"Ledda","year":"2025","journal-title":"Langenbeck\u2019s Arch Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"15335","DOI":"10.1038\/s41598-024-65320-w","article-title":"Prediction of anastomotic insufficiency based on the mucosal microbiome prior to colorectal surgery: A proof-of-principle study","volume":"14","author":"Lehr","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Guccione, C., Yadlapati, R., Shah, S., Knight, R., and Curtius, K. (2021). Challenges in Determining the Role of Microbiome Evolution in Barrett\u2019s Esophagus and Progression to Esophageal Adenocarcinoma. Microorganisms, 9.","DOI":"10.3390\/microorganisms9102003"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19525","DOI":"10.1038\/s41598-024-67410-1","article-title":"Microbiome of esophageal endoscopic wash samples is associated with resident flora in the esophagus and incidence of cancer","volume":"14","author":"Shijimaya","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Yano, Y., Etemadi, A., and Abnet, C.C. (2021). Microbiome and Cancers of the Esophagus: A Review. Microorganisms, 9.","DOI":"10.3390\/microorganisms9081764"},{"key":"ref_34","unstructured":"World Medical Association Declaration of Helsinki (2001). Ethical principles for medical research involving human subjects. Bull. World Health Organ., 79, 373\u2013374."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/nyas.13676","article-title":"Surgical robotics for esophageal cancer","volume":"1434","author":"Grimminger","year":"2018","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2939","DOI":"10.1111\/1462-2920.12362","article-title":"Comparing the anterior nare bacterial community of two discrete human populations using Illumina amplicon sequencing","volume":"16","author":"Oxley","year":"2014","journal-title":"Environ. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1038\/nmeth.3869","article-title":"DADA2: High-resolution sample inference from Illumina amplicon data","volume":"13","author":"Callahan","year":"2016","journal-title":"Nat. Methods"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e61217","DOI":"10.1371\/journal.pone.0061217","article-title":"phyloseq: An R package for reproducible interactive analysis and graphics of microbiome census data","volume":"8","author":"McMurdie","year":"2013","journal-title":"PLoS ONE"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/nar\/25.1.109","article-title":"The RDP (Ribosomal Database Project)","volume":"25","author":"Maidak","year":"1997","journal-title":"Nucleic Acids Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"5261","DOI":"10.1128\/AEM.00062-07","article-title":"Naive Bayesian classifier for rapid assignment of rRNA sequences into the new bacterial taxonomy","volume":"73","author":"Wang","year":"2007","journal-title":"Appl. Environ. Microbiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/10\/1033\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T12:30:23Z","timestamp":1760531423000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/10\/1033"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,15]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["antibiotics14101033"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14101033","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,15]]}}}