title: The relevance of microbiology in the management of anorectal sepsis.
abstract: Eighty patients with anorectal sepsis were studied over three years. All abscesses were drained and pus was submitted for culture. If a fistula was found when the abscess was drained it was laid open otherwise a second examination under anaesthetic was performed within 7-10 days. In no case was sterile pus obtained. Gut aerobes, predominantly Escherichia coli, were isolated from 49 of 53 (92.5%) of patients with a fistula and 8 of 27 (29.6%) of those without. 'Gut-specific bacteroides' predominantly Bacteroides fragilis were isolated from 47 of 53 (88.7%) patients with a fistula and 5 of 27 (18.5%) of those without. Anaerobes not specific to the gut, predominantly B. asaccharolyticus, B. ureolyticus, peptococci and peptostreptococci, in the absence of those specific to the gut, were isolated from 2 of 53 patients with a fistula (3.8%) and 17 of 27 (63%) of those without. Staphylococcus aureus was isolated from only 1 of 53 (1.9%) patients with a fistula but from 8 of 27 (29.6%) of those without. It is concluded that only patients with gut-specific organisms should be submitted to a second examination under anaesthetic and that culture of pus in anorectal sepsis is an essential part of its management.
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000208:Acute Disease; D001004:Anus Diseases / Q000382:microbiology*; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D012002:Rectal Diseases / Q000382:microbiology*; D012003:Rectal Fistula / Q000382:microbiology