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Pus swabs in incision and drainage of perianal abscesses: what is the point?

Edmund Leung1, Kirsten McArdle, Marcelino Yazbek-Hanna

  • 1Department of Surgery, Queen's Hospital, Burton-on-Trent DE13 0RB, UK. ed.leung@doctors.org.uk

World Journal of Surgery
|August 7, 2009
PubMed
Abstract

Insights

Routine microbiological analysis of pus swabs from perianal abscesses may not be necessary. This study suggests that omitting pus swabs does not negatively impact treatment outcomes or fistula development.

Area of Science:

  • Colorectal Surgery
  • Surgical Microbiology
  • Clinical Effectiveness Research

Background:

  • The clinical utility and cost-effectiveness of routine microbiological analysis of pus swabs during incision and drainage for perianal abscesses remain debated.
  • Overlooked cost implications of microbiological investigations are a significant concern in resource allocation.

Purpose of the Study:

  • To evaluate whether omitting pus swab submission impacts the clinical outcomes of perianal abscess treatment.
  • To assess the correlation between microbiological findings and treatment success or complication rates.

Main Methods:

  • Retrospective review of 235 consecutive perianal abscess cases undergoing incision and drainage (January 2004-2008).
  • Analysis of patient demographics, microbiological results, and clinical outcomes over a 6-month follow-up period.

Main Results:

  • Microbiological results were infrequently utilized in follow-up (1.7% of cases).
  • No statistically significant association was found between the presence of coliform/Bacteroides in swabs and the development of fistulas (P > 0.05).
  • 185 out of 235 abscesses healed within 6 months; 39 cases developed fistulas.

Conclusions:

  • Surgeons often do not review microbiological results, suggesting limited impact on clinical decision-making.
  • Preliminary data indicate no correlation between microbiological findings and fistula formation or overall prognosis.
  • Further randomized controlled trials are recommended to definitively assess the impact of discontinuing pus swab submission on treatment effectiveness.

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