M. P. Shaughnessy1, C. J. Park1, L. Zhang1, R. A. Cowles1 1Yale University School Of Medicine,Department Of Pediatric Surgery,New Haven, CT, USA
Introduction:
Pilonidal, buttock, and perianal abscesses are common reasons for surgical consultation in the pediatric emergency department. When an abscess is clearly present, a bedside incision and drainage (I&D) typically includes a culture swab of the abscess fluid and patients are often discharged home with oral antibiotics. To fill a clear gap in the literature regarding culture utility and add to the existing data about antibiotic stewardship, we aimed to study abscess culture results by examining the impact of culture data on changes in management and effects on outcomes.We hypothesized that in a majority of cases, management is unaffected by culture data and therefore fluid culture from simple pilonidal, buttock, and perianal abscesses in the pediatric population may represent an unnecessary laboratory test and cost.
Methods:
With institutional review board approval, a single institution electronic medical record was searched to identify pediatric patients with a diagnosis of abscess having undergone I&D between February 1, 2013 and August 1, 2017. Two separate searches were conducted using both ICD-10 codes and CPT codes. Patients from these searches were merged, duplicates removed, and any patients with abscesses outside the gluteal region were excluded. From the resulting 317 patient encounters, 68 were excluded due to either improper coding or procedures having been performed outside of the pediatric emergency department. The final number of patient encounters was 249. Patients were divided into two different comparison groups for data analysis based upon the presence or absence of culture and recurrence or no recurrence. Data were analyzed with the support of SPSS Version 24.0 using chi-squared test or Fisher’s exact test when applicable.
Results:
Patient age distribution was bimodal with median ages of 1 and 16 years. Abscesses were more likely to occur in females (63.1%) than in males (36.9%). The most common abscess location was the gluteal cleft (46.6%), the most frequently cultured organism MRSA (26.1%), and the overall recurrence rate was 10.8%. Antibiotics were prescribed 80.3% of the time with the most commonly prescribed being Bactrim (34.5%), followed by Clindamycin (30.9%). In total, culture results were found to directly alter management in only 5 patient encounters (2.7%). When comparing groups by culture or no culture, no statistically significant difference in recurrence rate (p=0.4) was noted. When comparing groups by recurrence versus no recurrence, we found no statistically significant difference between sex (p=0.68), age (p=0.11), resident type (p=0.28), vessel loop use (p=0.2), packing use (p=0.28), or antibiotic use (p=0.17).
Conclusion:
We conclude that microbiological culture results are of limited utility in the management of pediatric pilonidal, gluteal, and perianal abscesses as they do not appear to alter treatment plans and omission of culture is not associated with failure of surgical management.