Microbiological Analysis of Perianal Abscess and Its Treatment

肛門膿瘍的菌種分析與治療

鄭勝方(Sheng-Fang Cheng) ； 蔡文司(Wen-Sy Tsai)

《中華民國大腸直腸外科醫學會雜誌》 21卷1期 (2010/03) Pp. 37-42

https://doi.org/10.6312/SCRSTW.2010.21(1).09817

摘要

目的　這項研究主要是尋找肛門膿瘍最常見的感染菌種，以及對抗這些菌種最有效的抗生素。
方法　我們需要的病人是單純肛門膿瘍患者。肛門膿瘍伴隨肛門廔管的病人必須先排除。是否是單純肛門膿瘍患者，由同一位醫師利用相同的檢查來診斷。從2006年3月至2007年7月，共16位病人加入本研究。
結果　每個病人的肛門膿瘍均可培養出嗜氧菌，而16個患者中，有14個人可培養出厭氧菌。嗜氧菌當中以E-coli最常見，厭氧菌中以Bacteroides fragilis最常見。E-coli對cefazolin 84.6%的病人有敏感性，E-coli 對augemtin 84.6%的病人有敏感性，而對amikacin 100%的病人有敏感性。Bacteroids fragilis對metronidazole 100%的病人敏感性。
結論　對抗肛門膿瘍所培養出細菌的最佳口服抗生素是Augentin加metronidazole或者是cefazolin 加metronidazole。

關鍵字

肛門膿瘍 ； 廔管

並列摘要

Purpose. To identify the species of infectious organisms present in perianal abscesses and to determine their sensitivity to various antibiotics in order to establish the most effective type of oral antibiotics for treatment.
Patients and Methods. Sixteen patients with perianal abscess without skin rupture or identified fistula tract were included in this study. After disinfecting the skin with povidone-iodine and alcohol, exudate was aspirated from the abscess by using a 5-cc needle syringe and sent for common aerobic and anaerobic culture and antibiotic sensitivity tests.
Results. The culture rates of aerobic and anaerobic bacteria were 100% and 87.5%, respectively. The species of aerobic bacteria identified included Escherichia coli (13/16), Streptococcus spp. (4/16), Klebsiella pneumoniae (4/16), Citrobacter freundii (2/16), Salmonella enterica serogroup D (1/16), and Staphylococcus aureus (1/16). The species of anaerobic bacteria included Bacteroides fragilis (10 of 14 patients), Bacteroides vulgatus (1/14), Bacteroides stercoris (1/14), Bacteroides thetaiotaomicron (1/14), and Clostridium perfringens (1/14). The most common cultured anaerobic and aerobic bacteria were B. fragilis and E.coli, respectively. Antibiotic sensitivity rates for E.coli were determined to be 84.6%, 84.6%, 69.2%, and 30.8% to amoxicillin-clavulamic acid, cefazolin, ciprofloxacin, and piperacillin, respectively. The resistant rate of E. coli to gentamycin was 30.8%, but the resistant rate to amikacin was 0%. For anaerobic bacteria, antibiotic sensitivity rates were determined to be 100%, 78.6%, 71.4% and 57.1% to the chemicals metronidazole, ampicillin-sulbactam, piperacillin, and clindamycin, respectively. The rates of fistula development at the 12-month follow-up were 28.6% and 0% in patients who had mixed flora and pure aerobic infection, respectively.
Conclusion. Our findings show that the first choice of oral antibiotics for the treatment of perianal abscess should be metronidazole combined with augamentin or cefazolin. If aminoglycosides are considered necessary in cases of severe infection, it is recommended that amikacin be administered as our results show a high rate of resistance to gentamycin.

並列關鍵字

Perianal abscess ； Antibiotics ； Anal fistula