MRSA-related perianal abscesses: An underrecognized disease entity
MRSA-related perianal abscesses: An underrecognized disease entity
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DOI：
10.1007/s10350-007-0221-x
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发表时间：
2007-07-01
影响因子：
3.9
通讯作者：
Bailey, H. Randolph
中科院分区：
文献类型：
--
作者：
Albright, Jeffrey B.;Pidala, Mark J.;Bailey, H. Randolph
目的：肛周脓肿中的耐甲氧西林金黄色葡萄球菌(MRSA)是一种未被充分认识的疾病。目前尚不清楚这些脓肿在表现或其他特征上是否与非MRSA对应的不同。方法：对2003年1月至2005年9月间确诊为肛周脓肿患者行切开引流术的临床资料进行回顾性分析。收集患者的人口学特征、脓肿特征(硬结、红斑、脓肿大小、脓肿量)、培养中是否存在MRSA、MRSA易感性和临床病程。结果：共有104例患者(62.5%男性，平均年龄42.7±13.7岁)接受了肛周脓肿的治疗。在引流培养的69例患者中，34.8%(24/69)的患者存在MRSA(95%可信区间，24.6-46.6%)。在年龄、MRSA危险因素、症状持续时间、入院时白细胞计数或住院时间方面，MRSA阳性患者与MRSA阴性患者没有显著差异。出现广泛硬结(优势比为6.52；P=0.003)、广泛红斑(优势比为5.75；P=0.003)或少量脓肿(优势比为9.72；P=0.006)的患者更容易出现MRSA阳性。坐骨神经直肠脓肿的耐甲氧西林金黄色葡萄球菌阳性的可能性显著降低(优势比，0.34；P=0.016)。MRSA阳性脓肿患者无一例发生瘘管。所有耐甲氧西林金黄色葡萄球菌对β-内酰胺类抗生素耐药，对喹诺酮类药物敏感性有限。结论：MRSA在肛周脓肿中的患病率以前没有被描述过，并且在我们的患者组中比预期的要高。MRSA阳性的患者不能仅通过危险因素来识别。耐甲氧西林金黄色葡萄球菌的耐药谱不同于典型的肛周脓肿的肠道细菌。因此，培养所有有广泛硬结和红斑或轻度脓肿的肛周脓肿可能是有益的。
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 P-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.