TY - JOUR
T1 - MRSA-related perianal abscesses
T2 - An underrecognized disease entity
AU - Albright, Jeffrey B.
AU - Pidala, Mark J.
AU - Cali, Joseph R.
AU - Snyder, Michael J.
AU - Voloyiannis, Theodoros
AU - Bailey, H. Randolph
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007/7
Y1 - 2007/7
N2 - PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) in perianal abscesses represents an underrecognized condition. It is unclear whether these abscesses differ in presentation or other characteristics from their non-MRSA counterparts. METHODS: Patients diagnosed with perianal abscess, who underwent incision and drainage between January 2003 and September 2005, were identified retrospectively. Demographics, abscess characteristics (induration, erythema, abscess size, amount of purulence), presence of MRSA on culture, MRSA susceptibilities, and clinical course were collected. RESULTS: A total of 104 patients (62.5 percent male; mean age, 42.7 ± 13.7 years) were treated for perianal abscess. For the 69 patients cultured at drainage, MRSA was present in 34.8 percent (24/69) of cases (95 percent confidence interval, 24.6-46.6 percent). MRSA-positive patients did not significantly differ from MRSA-negative patients with respect to age, MRSA risk factors, duration of symptoms, white blood cell count at admission, or length of stay. Patients were more likely to be MRSA-positive if they possessed extensive induration (odds ratio, 6.52; P = 0.003), extensive erythema (odds ratio, 5.75; P = 0.003), or small amount of purulence (odds ratio, 9.72; P = 0.006). Ischiorectal abscesses were significantly less likely to be MRSA-positive (odds ratio, 0.34; P = 0.016). No patients with MRSA-positive abscesses developed fistulas. All MRSA isolates were resistant to β-lactam antibiotics and had limited susceptibility to quinolones. CONCLUSIONS: The prevalence of MRSA in perianal abscesses has not been described previously and is higher in our group of patients than would be expected. MRSA-positive patients cannot be identified by risk factors alone. Antibiotic resistance spectra of MRSA vary from that of enteric bacteria typically seen in perianal abscesses. Therefore, it may be beneficial to culture all perianal abscesses with extensive induration and erythema or minimal purulence.
AB - PURPOSE: Methicillin-resistant Staphylococcus aureus (MRSA) in perianal abscesses represents an underrecognized condition. It is unclear whether these abscesses differ in presentation or other characteristics from their non-MRSA counterparts. METHODS: Patients diagnosed with perianal abscess, who underwent incision and drainage between January 2003 and September 2005, were identified retrospectively. Demographics, abscess characteristics (induration, erythema, abscess size, amount of purulence), presence of MRSA on culture, MRSA susceptibilities, and clinical course were collected. RESULTS: A total of 104 patients (62.5 percent male; mean age, 42.7 ± 13.7 years) were treated for perianal abscess. For the 69 patients cultured at drainage, MRSA was present in 34.8 percent (24/69) of cases (95 percent confidence interval, 24.6-46.6 percent). MRSA-positive patients did not significantly differ from MRSA-negative patients with respect to age, MRSA risk factors, duration of symptoms, white blood cell count at admission, or length of stay. Patients were more likely to be MRSA-positive if they possessed extensive induration (odds ratio, 6.52; P = 0.003), extensive erythema (odds ratio, 5.75; P = 0.003), or small amount of purulence (odds ratio, 9.72; P = 0.006). Ischiorectal abscesses were significantly less likely to be MRSA-positive (odds ratio, 0.34; P = 0.016). No patients with MRSA-positive abscesses developed fistulas. All MRSA isolates were resistant to β-lactam antibiotics and had limited susceptibility to quinolones. CONCLUSIONS: The prevalence of MRSA in perianal abscesses has not been described previously and is higher in our group of patients than would be expected. MRSA-positive patients cannot be identified by risk factors alone. Antibiotic resistance spectra of MRSA vary from that of enteric bacteria typically seen in perianal abscesses. Therefore, it may be beneficial to culture all perianal abscesses with extensive induration and erythema or minimal purulence.
KW - Abscess
KW - Anus diseases
KW - Methicillin resistance
KW - Methicillin-resistant Staphylococcus aureus
KW - Rectal fistula
KW - Staphylococcus aureus
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U2 - 10.1007/s10350-007-0221-x
DO - 10.1007/s10350-007-0221-x
M3 - Article
C2 - 17525863
AN - SCOPUS:34447099182
VL - 50
SP - 996
EP - 1003
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 7
ER -