Chakarov Dzhevdet, Hadzhieva Elena, Kalchev Yordan, Hadzhiev Dimitar
Section of General Surgery, Department of Propedeutics of Surgical Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria.
First Clinic of Surgery, University Hospital St. George, 4001 Plovdiv, Bulgaria.
J Clin Med. 2024 Apr 20;13(8):2414. doi: 10.3390/jcm13082414.
: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. : We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010-2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin-methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l'Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer-Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. : Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. , , and were the most frequently isolated. In addition, was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. : The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.
小儿直肠肛管脓肿是一种相对罕见的疾病。最常受累的是1岁以下的男童。对于此类患者的诊断和治疗，微生物学检查的重要性在外科医生中仍存在争议，导致文献中可用数据稀少。我们旨在确定接受手术治疗直肠肛管脓肿的儿童分离株的需氧微生物谱和抗生素耐药性。
我们对10年间（2010 - 2019年）诊断并接受手术治疗直肠肛管脓肿的102例儿童进行了病例系列研究。脓性伤口渗出物用于微生物学评估，随后在5%羊血琼脂和伊红美蓝琼脂上培养。对于微生物鉴定，使用了传统生化试验和半自动（API 20，法国生物梅里埃公司，马西 - 埃图瓦勒）试验以及自动化系统（Vitek - 2 Compact，法国生物梅里埃公司）。抗菌药物敏感性试验采用鲍尔 - Kirby纸片扩散法并测定糖肽类的最低抑菌浓度。结果根据相应年份的欧盟CAST标准进行解读。
接受直肠肛管脓肿手术的儿童的微生物学检测主要鉴定出通常存在于直肠黏膜的肠道共生菌。略多于半数的病例中发现单一培养物。 、 和 是最常分离出的菌株。此外，7%的患者中发现了 。在革兰氏阴性菌中，青霉素、头孢菌素、磺胺类和氟喹诺酮类抗生素耐药最为常见。
抗菌药物耐药率的上升使得有必要对儿童直肠肛管脓肿相关的循环共生菌进行本地监测，以便在有指征时指导抗生素治疗。
