Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis

Mocanu, Valentin; Dang, Jerry; Ladak, Farah; Tian, Chunjie; Wang, Haili; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1016/j.amjsurg.2019.01.015

Cited by 46 publications

(40 citation statements)

References 15 publications

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“…Keeping the Parks cryptoglandular theory in mind, it would be expected that antibiotics would play a protective role in development of fistulas. While the literature does show trends of this being the case [12,13] and meta-analysis of the data showed the same [14], our data did not follow the same trend. This could be due to there being no standard-ization to the prescription or regimentation given in terms of agents, dosage, and duration.…”

Section: Discussion/conclusioncontrasting

confidence: 67%

Incidence and Risk Factors Affecting Development of Perianal Fistulas after Drainage of Perianal Abscesses

Khalil¹,

Al-Ozaibi²,

Kaiyasah³

et al. 2021

Dubai Med J

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Background: Perianal fistulas can present significant morbidity and detriment to a patient’s quality of life. This study aimed to quantify the incidence of perianal fistulas and attempted to identify any risk factors for their development. Materials and Methods: This retrospective study reviewed all patients who underwent drainage of first-time perianal abscesses in Rashid Hospital from 2014 to 2018. Noncryptoglandular causes of fistula formation were excluded after which incidence and risk factors were investigated. Results and Discussion: A total of 445 records were reviewed of which 131 met the inclusion criteria (103 males and 28 females). The median age of patients was 37 with ranges of 15–85. There was no statistically significant finding relating to gender (p value = 1.00), smoking (p value = 1.00), location of perianal abscess (p value = 0.347), and postoperative antibiotics (p value = 0.694). There was no statistically significant finding relating to patients below or above 40 (p value = 0.846), and logistic regression testing revealed no statistical significance in age relating to development of perianal fistulas. There was a 13.2% increased proportion of nondiabetics to develop perianal fistulas as compared to diabetics (32 vs. 19%), but it was not found to be statistically significant (p value = 0.236). Conclusion: None of the risk factors studied were found to be statistically significant in the development of perianal fistulas after drainage of perianal abscesses and the incidence was found to be 29.8%.

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Section: Discussion/conclusioncontrasting

confidence: 67%

Incidence and Risk Factors Affecting Development of Perianal Fistulas after Drainage of Perianal Abscesses

Khalil¹,

Al-Ozaibi²,

Kaiyasah³

et al. 2021

Dubai Med J

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“…It is possible that the proportion of patients with anal fistula who undergo radical resection is decreasing; however, do some of these patients actually form anal fistula? At present, there is increasing evidence that the proportion of patients who experience the formation of secondary anal fistula after perianal sepsis is not very high [13][14][15][16][17][18][19]. A large sample of data from the United Kingdom found that the incidence of secondary anal fistula after perianal sepsis incision and drainage was 15.5% [8].…”

Section: Discussionmentioning

confidence: 99%

Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors

et al. 2020

BMC Surg

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Background: The choice of surgery for perianal sepsis is currently controversial. Some people advocate one-time radical surgery for perianal sepsis, while others advocate incision and drainage. The objective of this study is to observe the formation probability of secondary anal fistula after incision and drainage in patients with perianal sepsis and determine factors that contribute to secondary anal fistula after incision and drainage. Methods: A retrospective descriptive analysis was conducted in 288 patients with perianal sepsis who were treated with anorectal surgery in the Suzhou Hospital of Traditional Chinese Medicine from January 2016 to June 2018. The patients were followed by telephone, physical examination, and pelvic MRI examination for at least 1 year after surgery. Results: Three patients were not followed, 98 patients did not receive surgical treatment or one-time radical surgery for perianal sepsis, and 187 patients were ultimately identified for the study. Anal fistula was present in 105 patients, and the rate of formation of secondary anal fistula was 56.15%. There was no statistically significant difference in the fistula formation rate between different types of sepsis (P>0.05). And, in patients with secondary anal fistula, there was no significant correlation between the location of sepsis and the type of secondary anal fistula (P>0.05). Conclusions: The incidence of secondary anal fistula after incision and drainage of perianal sepsis is 56.15%, which is lower than the incidence found in previous study. Young is a risk factor for secondary anal fistula after incision and drainage of perianal sepsis. There is no significant correlation between the location of sepsis and the type of secondary anal fistula. Simple incision and drainage is a suitable choice for patients with acute perianal sepsis.

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“…24 A recent meta-analysis concluded that the administration of antibiotics was associated with significant reduction in the risk of fistula formation after anorectal abscess drainage. 25…”

Section: Discussionmentioning

confidence: 99%

Regular Low-Dose Oral Metronidazole Is Associated With Fewer Vesicovaginal and Rectovaginal Fistulae in Recurrent Cervical Cancer: Results From a 10-Year Retrospective Cohort

George

Prasoona

Kandasamy

et al. 2019

JGO

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PURPOSE Anaerobic necrosis in cervical cancer can lead to malodor, fistulae, and treatment abandonment. In this retrospective cohort study, we examined the association between maintenance metronidazole and the incidence of malignant fistulae in recurrent cervical cancer. METHODS We screened all cervical cancer records registered between 2007 and 2016 in the local palliative care database at Christian Medical College, Vellore, India. There were 208 eligible patients with post-treatment residual/recurrent pelvic disease. Among them, 76 had received oral maintenance metronidazole 200 mg once per day for 2 to 86 weeks (interquartile range, 4-16 weeks). RESULTS Seventy-two patients developed at least one fistula. Forty-nine had vesicovaginal fistulae, 10 had rectovaginal fistuale, and 13 developed both types of fistulae. Patients on maintenance metronidazole had fewer fistulae (22.4% v 41.7%; P = .005), a longer median fistula-free survival (42.9 months v 14.1 months; P < .001), and a postrecurrence survival of 11.5 months versus 8.7 months ( P = .112). We performed Cox multivariable proportional hazards regression analysis on the data from the subset of 146 patients observed until death. Bladder/rectal infiltration had a higher risk of fistula (HR, 5.24; P = .011), whereas distant metastases (HR, 2.46; P = .012) and Eastern Cooperative Oncology Group performance status greater than 1 (HR, 1.64; P = .008) were associated with a higher risk of death. Maintenance metronidazole was associated with a lower risk of fistula (hazard ratio [HR], 0.33; 95% CI, 0.16 to 0.67; P = .002) and a lower risk of death (HR, 0.56; 95% CI, 0.39 to 0.81; P = .002). CONCLUSION Our data indicate that there is a significant inverse association between oral maintenance metronidazole and malignant fistulae in locally recurrent cervical cancer. The impact of this simple intervention on pelvic symptoms, fistulae, and survival should be evaluated in prospective studies.

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Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses: A systematic review and meta-analysis

Cited by 46 publications

References 15 publications

Incidence and Risk Factors Affecting Development of Perianal Fistulas after Drainage of Perianal Abscesses

Incidence and Risk Factors Affecting Development of Perianal Fistulas after Drainage of Perianal Abscesses

Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors

Regular Low-Dose Oral Metronidazole Is Associated With Fewer Vesicovaginal and Rectovaginal Fistulae in Recurrent Cervical Cancer: Results From a 10-Year Retrospective Cohort

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