A second look at anorectal infections in cancer patients in a large cancer institute: the success of early intervention with antibiotics and surgery.
BACKGROUND
Infection of anorectal region represents a significant complication of anti-cancer therapy. Anorectal infection occurs in patients receiving aggressive chemotherapy. Untreated infection leads to substantial morbidity and in the past, mortality.


METHODS
82 episodes of anorectal infection in 64 patients with malignant diseases occurring over 12 years at the National Cancer Institute (NCI) were retrospectively reviewed.


RESULTS
The overall incidence is comparable to the prior NCI experience despite a shift in patient population to a lower percentage of lymphoid/leukemic diagnoses (34% vs 77%). There were no deaths associated with anorectal infection in the 12 years reviewed compared to seven of 44 in the previous decade (p = 0.003). Antibiotic therapy alone was successful in managing 25/82. Only five episodes were treated with surgery alone compared to nearly 45% in the previous decade. There were no major surgical complications. Neutropenia was present in 43/82 episodes. 11 episodes were complicated by bacteremia, predominately with Staphylococcus non- aureus (n = 8). Wound cultures were performed in 36 episodes from 23 patients yielding 99 separate isolates. Gram-negative isolates were most common overall. Modification of antibiotic therapy with further anaerobic coverage was administered successfully in 39/77 episodes.


CONCLUSIONS
This study illustrates that anorectal infections in cancer patients can be successfully managed with antibiotic therapy and local care; surgery can be withheld unless there is evidence of progressive infection or substantial fluctuance and necrosis.
Lehrnbecher
T
T
Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Marshall
D
D
Gao
C
C
Chanock
S J
SJ
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D001004:Anus Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis; D016522:Oncology Service, Hospital; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents