Department of Surgery, Section of Pediatric Surgery at Yale University, New Haven, Connecticut.
Department of Surgery, Section of Pediatric Surgery at Yale University, New Haven, Connecticut.
J Surg Res. 2019 Jul;239:208-215. doi: 10.1016/j.jss.2019.02.017. Epub 2019 Mar 6.
Pilonidal, buttock, and perianal abscesses are common reasons for surgical consultation in the pediatric emergency department. Treatment typically includes a bedside incision and drainage, often followed by an abscess culture, and a course of oral antibiotics. We aimed to study the impact of culture data on changes in management and clinical outcomes. We hypothesized that management is unaffected by culture data, and therefore, fluid culture from pilonidal, buttock, and perianal abscesses in the pediatric population may represent an unnecessary laboratory test and cost.
A single institution's electronic medical record was searched between February 1, 2013 and August 1, 2017, identifying 249 pediatric patients meeting the inclusion criteria: age 0 to 18 y; diagnosis of pilonidal, buttock, or perianal abscess; bedside incision and drainage. Patients were divided into two different comparison groups for data analysis based on the presence or absence of culture and recurrence or no recurrence.
Culture results directly altered management in only 5 patient encounters (2.7% of all cultured). When comparing groups by culture or no culture, no statistically significant difference in recurrence rate (P = 0.4) was noted. When comparing groups by recurrence versus no recurrence, we found no statistically significant difference between sex, resident type, vessel loop use, packing use, or antibiotic use (P > 0.05).
We conclude that microbiological culture results are of limited utility in the management of pediatric pilonidal, buttock, and perianal abscesses as they do not appear to alter treatment, and omission of culture is not associated with failure of surgical management.
藏毛窦、臀部和肛周脓肿是小儿急诊科外科会诊的常见原因。治疗通常包括床边切开引流，通常随后进行脓肿培养和口服抗生素疗程。我们旨在研究培养数据对管理和临床结果的影响。我们假设培养数据不会影响治疗，因此，小儿藏毛窦、臀部和肛周脓肿的液体培养可能代表一种不必要的实验室检查和费用。
在 2013 年 2 月 1 日至 2017 年 8 月 1 日期间，对单机构的电子病历进行了搜索，确定了符合纳入标准的 249 名儿科患者：年龄 0 至 18 岁；诊断为藏毛窦、臀部或肛周脓肿；床边切开引流。根据是否存在培养和复发或不复发，将患者分为两组进行数据分析。
仅在 5 次患者就诊（所有培养的 2.7%）中，培养结果直接改变了治疗方法。当根据培养或无培养对组进行比较时，复发率无统计学差异（P=0.4）。当比较复发与不复发的组时，我们发现性别、住院医师类型、血管环使用、填塞使用或抗生素使用之间无统计学差异（P>0.05）。
我们得出结论，微生物培养结果在小儿藏毛窦、臀部和肛周脓肿的管理中用处有限，因为它们似乎不会改变治疗方法，并且省略培养不会导致手术管理失败。
