与耐甲氧西林金黄色葡萄球菌（MRSA）相关的直肠周围脓肿感染：一种普遍存在但认识不足的病原体。

Department of Surgery, William Beaumont Army Medical Center, 5005 N. Piedras Street, El Paso, TX 79920, USA.

J Surg Educ. 2009 Sep-Oct;66(5):264-6. doi: 10.1016/j.jsurg.2009.07.013.

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) is not a commonly recognized pathogen isolated from perirectal abscesses. Complex perirectal abscesses of MRSA origin may present a significant challenge to the physician and result in treatment failure. The aim of our study was to determine the prevalence of MRSA in our patient population with perirectal abscesses and whether antibiotics coverage, if given, was adequate.

METHODS

We conducted a retrospective study of all adult patients who presented with a perirectal abscess. The bacteriology of the cultures taken from more than 100 patients during an 8-year period was examined. The prevalence of MRSA was specifically analyzed, and the sensitivities of the organisms isolated were then compared with any antibiotics prescribed to determine the adequacy of coverage.

RESULTS

In all, 124 patients were treated for perirectal abscess during the 8-year period. Fifty-nine percent of patients were taken to the operating room for incision and drainage, 52% of the patients had cultures taken of the abscess, and 35% of patients were given antibiotics coupled with incision and drainage. The antibiotics offered adequate coverage when compared with the sensitivities of the organisms 73% of the time. The prevalence of MRSA in our patient population was 19%, and when this organism was cultured, the patient only received adequate coverage 33% of the time.

CONCLUSION

The presence of MRSA in perirectal abscesses is underrecognized. Recent data has shown that incision and drainage combined with antibiotics offers a superior outcome in soft tissue abscesses caused by this organism. If cultures are not routinely taken at the time of incision and drainage, the institutional incidents of MRSA will remain unknown. Physicians must recognize that MRSA is a potential organism present in perirectal abscesses when considering antimicrobial therapy for complex abscesses.

背景

耐甲氧西林金黄色葡萄球菌（MRSA）并非从直肠周围脓肿中分离出的常见病原体。由 MRSA 引起的复杂直肠周围脓肿可能会给医生带来重大挑战，并导致治疗失败。我们的研究目的是确定我们的直肠周围脓肿患者人群中 MRSA 的流行率，以及所给予的抗生素治疗是否充分。

方法

我们对所有患有直肠周围脓肿的成年患者进行了回顾性研究。在 8 年期间对 100 多名患者的培养物进行了细菌学检查。专门分析了 MRSA 的流行率，然后将分离出的细菌的敏感性与所开的任何抗生素进行比较，以确定覆盖范围是否充分。

结果

在 8 年期间，共有 124 名患者接受了直肠周围脓肿的治疗。59%的患者接受了手术切开引流，52%的患者进行了脓肿培养，35%的患者接受了抗生素联合切开引流。抗生素的覆盖范围与细菌的敏感性相比，有 73%的时间是充分的。我们的患者人群中 MRSA 的流行率为 19%，当培养出这种细菌时，患者只有 33%的时间接受了充分的覆盖。