Microbiological Testing and Antibiotic Resistance in Patients Undergoing Drainage for Perianal Abscess: A Retrospective Observational Cohort Study

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Bölük S. E., Bölük S., Karatepe Y. K., Şenol Z.

Turkish Journal of Colorectal Disease, cilt.35, sa.4, ss.109-116, 2025 (Scopus, TRDizin)

Özet

Aim: Despite the widespread use of empiric antibiotics, the role of routine microbiological testing in patients with perianal abscesses to guide treatment remains uncertain. This study aimed to assess the rate of microbiological testing, the spectrum of pathogens identified, and their antibiotic resistance profiles in patients who underwent surgical drainage of perianal abscess. Method: A single-center retrospective study was conducted on 141 adult patients who underwent incision and drainage for perianal abscesses between January 2017 and March 2024. The attending surgeon decided whether to obtain intraoperative bacteriological culture samples. Clinical characteristics, culture results, and antibiotic resistance profiles were analyzed. Results: Microbiological testing was performed in 32.6% of patients. Bacterial isolates were detected in 63.0% of the tested patients, with Escherichia coli (E. coli) (52.2%) and Klebsiella pneumoniae (K. pneumoniae) (10.8%) being the most frequently isolated bacteria. Antibiotic resistance rates were high, particularly for E. coli, with resistance to ampicillin (81.4%) and cefazolin (75.0%) being the most common. No resistance was observed to amikacin, colistin, or carbapenems. At a median follow-up of 93 days, 68.8% of the patients reported no sequelae, whereas 19.9% required further surgical intervention for perianal fistula. Conclusion: The results suggest that a considerable portion of perianal abscess cases harbor resistant pathogens, particularly E. coli and K. pneumoniae. Given the high rates of antibiotic resistance observed, routine microbiological testing may help guide targeted antibiotic therapy, especially in patients with complex or recurrent abscesses. Although microbiological testing revealed high resistance rates among common pathogens, the findings must be interpreted cautiously, given the retrospective design, limited use of microbiological testing, absence of anaerobic cultures, and delayed result availability.