Intra-abdominal and Anorectal Abscesses

Thompson, Dakota T.; Hrabe, Jennifer E.

doi:10.1016/j.gtc.2021.02.014

Cited by 3 publications

(4 citation statements)

References 69 publications

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“…Crohn´s disease (CD) is a chronic and relapsing inflammatory bowel disease characterized by transmural inflammation which can result in fistulae and intraabdominal abscess formations [ 1 , 2 ]. Therapeutic strategies for intraabdominal abscesses that occurs in up to 30% of patients suffering from Crohn´s disease include antibiotic treatment, interventional drainage, and surgical approaches [ 3 , 4 , 5 , 6 , 7 , 8 ]. International guidelines recommend a step-up approach with a combination of (empiric) antibiotic therapy and percutaneous CT- or ultrasound-guided drainage, if technically possible, to delay or even avoid surgery for intestinal resection [ 6 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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Intraabdominal abscess formation occurs in up to 30% of patients suffering from Crohn´s disease (CD). While international guidelines recommend a step-up approach with a combination of empiric antibiotic therapy and percutaneous drainage to delay or even avoid surgery, evidence about microbial spectrum in penetrating ileitis is sparse. We retrospectively assessed outcomes of 46 patients with terminal penetrating Ileitis where microbial diagnostics have been performed and compared microbial spectrum and antibiotic resistance profile of CD patients with patients suffering from diverticulitis with intraabdominal abscess formation. In both groups, the most frequently isolated pathogen was the gram-negative bacterium E. coli belonging to the family of Enterobacterales. However, overall Enterobacterales were significantly more often verifiable in the control group than in CD patients. Furthermore, microbial analysis showed significant differences regarding isolation of anaerobic pathogens with decreased frequency in patients with CD. Subgroup analysis of CD patients to evaluate a potential influence of immunosuppressive therapy on microbial spectrum only revealed that Enterobacterales was less frequently detected in patients treated with steroids. Immunosuppressive therapy did not show any impact on all other groups of pathogens and did not change antibiotic resistance profile of CD patients. In conclusion, we were able to demonstrate that the microbial spectrum of CD patients does differ only for some pathogen species without increased rate of antibiotic resistance. However, the empiric antibiotic therapy for CD-associated intra-abdominal abscess remains challenging since different points such as local epidemiological and microbiological data, individual patient risk factors, severity of infection, and therapy algorithm including non-surgical and surgical therapy options should be considered before therapeutical decisions are made.

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Section: Introductionmentioning

confidence: 99%

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Kusan

Surat

Kelm

et al. 2022

JCM

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“…Rates of sepsis were higher in the opioid use group, but rates of abscess formation were lower, which is a perplexing finding. Firstly, intra-abdominal abscesses are most commonly caused by perforation, and resultant peritoneal seeding by intracolonic bacteria [ 20 ]. The increased risk of perforation from opioids, as discussed previously, should therefore predispose the patient to an increased risk of abscess and sepsis as well [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, intra-abdominal abscesses are most commonly caused by perforation, and resultant peritoneal seeding by intracolonic bacteria [ 20 ]. The increased risk of perforation from opioids, as discussed previously, should therefore predispose the patient to an increased risk of abscess and sepsis as well [ 20 , 21 ]. However, in our study, opioid use was associated with decreased rates of fistula formation.…”

Section: Discussionmentioning

confidence: 99%

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis

Shaikh¹,

Khrais²,

Le³

et al. 2023

Cureus

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Background and objectiveDiverticulitis occurs in 10-25% of patients with diverticulosis. Although opioids can decrease bowel motility, there is scarce data on the effect of chronic opioid use on the outcomes of diverticulitis. In this study, we aimed to explore the outcomes of diverticulitis in patients with pre-existing opioid use. MethodsData between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted using the International Classification of Diseases, 9th Revision (ICD-9) codes. Univariate and multivariate analyses were used to generate odds ratios (OR). Elixhauser Comorbidity Index (ECI) scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. Inclusion criteria included patients with a primary diagnosis of diverticulitis. Exclusion criteria included patients less than 18 years of age, and a diagnosis of opioid use disorder in remission. Studied outcomes included inpatient mortality, complications (including perforation, bleeding, sepsis event, ileus, abscess, obstruction, and fistula), length of hospital stay, and total costs. ResultsA total of 151,708 patients with diverticulitis and no active opioid use and 2,980 patients with diverticulitis and active opioid use were hospitalized in the United States from 2008 to 2014. Opioid users had a higher OR for bleeding, sepsis, obstruction, and fistula formation. Opioid users had a lower risk of developing abscesses. They had longer lengths of stay, higher total hospital charges, and higher Elixhauser readmission scores. ConclusionHospitalized diverticulitis patients with comorbid opioid use are at an elevated risk of in-hospital mortality and sepsis. This could be attributed to complications from injection drug use predisposing opioid users to these risk factors. Outpatient providers caring for patients with diverticulosis should consider screening their patients for opioid use and try offering them medication-assisted treatment to reduce their risk of poor outcomes.

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“…Numerous studies have pointed out that rapid gastrointestinal decompression with a nasogastric tube, PN or EN and broad-spectrum antibiotics are the basic treatments for duodenal stump fistulas [ 21 ]. Thus, early and adequate drainage of intra-abdominal abscesses is essential [ 22 ]. This often requires appropriate abdominal drainage tube placement in a suitable position.…”

Section: Discussionmentioning

confidence: 99%

Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study

Wang,

Ya,

Wang

et al. 2023

Surgery Open Science

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Intra-abdominal and Anorectal Abscesses

Cited by 3 publications

References 69 publications

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Microbial Spectrum and Antibiotic Resistance in Patients Suffering from Penetrating Crohn’s Disease

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis

Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study

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