Blondin Stanislas, Lobo David, Egal Axel, Ysmail-Dahlouk Saliha, Taouk Milad, Bourguignon Josée, Blondeel David, Etienney Isabelle
Department of Proctology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
Department of Anesthesia, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
Ann Coloproctol. 2025 Feb;41(1):40-46. doi: 10.3393/ac.2024.00472.0067. Epub 2025 Feb 3.
The role of antibiotics in preventing fistula formation following an initial abscess remains a subject of debate. This study compared the incidence of fistula in ano in patients experiencing their first episode of acute perianal sepsis, with and without antibiotic therapy, and evaluated the prevalence of fistula in ano necessitating surgical intervention at 1 year.
This retrospective cohort study was conducted at a tertiary care hospital with a dedicated proctology department. All patients who presented to the emergency proctology unit with a first episode of acute perianal sepsis were eligible for inclusion.
This study included 276 patients. At 1 year, fistula formation was identified in 65.6% of all patients, 54.0% of those who had received antibiotics, and 75.0% of those who had not (P<0.001). This finding remained significant after weighted propensity analysis (odds ratio, 0.53; 95% confidence interval, 0.31-0.92; P=0.025).
The rate of fistula formation was relatively high in this study. However, it was lower among patients with perianal sepsis who were treated with antibiotics, although a causal relationship could not be established. Prolonged follow-up is needed to clarify the role of antibiotic therapy in preventing or delaying fistula development in patients with acute perianal sepsis.
抗生素在预防初发性脓肿后肛瘘形成中的作用仍是一个有争议的话题。本研究比较了首次发生急性肛周脓毒症的患者在接受和未接受抗生素治疗的情况下肛瘘的发生率，并评估了1年后需要手术干预的肛瘘患病率。
这项回顾性队列研究在一家设有专门直肠科的三级医院进行。所有因首次急性肛周脓毒症就诊于直肠科急诊室的患者均符合纳入标准。
本研究纳入了276例患者。1年后，所有患者中有65.6%形成肛瘘，接受抗生素治疗的患者中有54.0%形成肛瘘，未接受抗生素治疗的患者中有75.0%形成肛瘘（P<0.001）。经过加权倾向分析后，这一发现仍然具有统计学意义（优势比，0.53；95%置信区间，0.31 - 0.92；P = 0.025）。
本研究中肛瘘形成率相对较高。然而，在接受抗生素治疗的肛周脓毒症患者中，肛瘘形成率较低，尽管无法确定因果关系。需要延长随访时间以阐明抗生素治疗在预防或延缓急性肛周脓毒症患者肛瘘发展中的作用。
