Inadequate antibiotic coverage in emergently operated complicated perirectal abscess has higher rates of readmission.

Author(s):
Rohit Rasane; Adrian Coleoglou Centeno; Marlon Torres; Christopher Horn; Qiao Zhang; Kelly Marie Bochicchio; Obeid Ilahi; John Mazuski; Grant Bochicchio

Background:

Recommended treatment for complicated perirectal abscess is Incision and drainage (I&D) in conjunction with antibiotics. However, there is no standard antibiotic regimen for postoperative therapy in the published literature.

Hypothesis:

Appropriate postoperative antibiotics in patients undergoing emergency I&D in the operating room (OR) for complicated perirectal abscess will improve outcomes.

Methods:

Data from 58 patients admitted for complicated perirectal abscess undergoing emergent I&D in the OR were prospectively collected. Demographics, microbiologic and antibiotic data were abstracted. Adequateness of antibiotics was judged by susceptibility data, when available, or by comparing the antibiotic spectrum with the organisms grown in culture, when not speciated. Students T test and X² test were used to analyze continuous and categorical variables respectively.

Results:

Of the 58 patients reviewed, 11 were excluded as no culture information was available, or the culture had no growth. Of the remaining 47 patients, 34(72%) were male and 30(64%) were African-American. The mean age was 39.1±16.4 years and the BMI was 28.2±6.6 Kg/m2. Culture data revealed mixed aerobic/anaerobic 18(38.3%), mixed aerobic 14(29.8%), Gram positives 10(21.3%), Gram negatives 2(4.3%), and other 3(6.4%). Twenty six (55.3%) patients received adequate antibiotic coverage and 21(44.7%) were inadequately covered. The inadequate antibiotic coverage cohort had higher re-admission rates for perirectal abscess drainage (n=6, 28.6% vs n=1, 3.8% p=0.035). More than half were readmitted 30 days or more after the index procedure. There were no differences in length of stay (LOS), ICU LOS and Charlson comorbidity index between groups.

Conclusions:

Inadequate antibiotic coverage after OR I&D resulted in a six-fold increase in re-admission for complicated perirectal abscess. A standard oral protocol combining antibiotics covering typical gram positive, gram negative and anaerobic organisms should provide adequate coverage for complicated perirectal abscess after surgical drainage. Additional prospective studies are needed to elucidate optimal antibiotic coverage for these patients.