Q: 73 years old male is admitted to the ICU from a Nursing Home (NH) due to pneumonia. While recovering, the patient also gets diagnosed with a perianal abscess. Surgical service drained it at the bedside. Per American Society of Colorectal Surgery (ASCRS) guidelines, all of the following make him eligible for a course of antibiotics EXCEPT?
A) Signs of systemic infection
B) End Stage Renal Disease
C) Diabetes
D) Valvular heart disease
E) Immunosuppression
Answer: B
Although conventionally all patients with perianal and perirectal abscesses get treatment with a course of antibiotics, to sustain stewardship towards unnecessary use of antibiotics, the American Society of Colorectal Surgery (ASCRS) guidelines suggest a course of empiric antibiotics after drainage of an anorectal abscess only in patients:
- Extensive perianal/perineal cellulitis
- Signs of systemic infection
- Diabetes
- Valvular heart disease
- Immunosuppression
This is because routine antibiotic use after drainage of an anorectal abscess does not protect against fistula formation. Said that clinical judgement supercedes any guidelines!
#ID
#surgical-critical-care
References:
1. Gaertner WB, Burgess PL, Davids JS, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum 2022; 65:964.
2. Sözener U, Gedik E, Kessaf Aslar A, et al. Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study. Dis Colon Rectum 2011; 54:923.
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