Pediatric Surgical Approach To Childhood Abscess: A Study From An Outpatient Facility

摘要

Background/aim: Percutaneous abscess drainage is a frequent procedure in the pediatric surgery outpatient setting. However it has it's own drawbacks in the treatment and follow–up. In this study we aimd to evaluate the patients with abscesses who had been treated surgically. Methods: Within 2.5 year period we investigated the total admissions, patinets with abscess, their register cards, age, abscess localization, complications, bacterial growth in the abscess materials, anaerobic and aerobic bacteria and antibiotic susceptibility of bacteria retrospectively. Results: Between Jan 1999 – April 2001, the total admission was 6127 patients. Admission with abscess was 58 (0.94%). Mean age was 3.5 years. (11 days – 15 years). Six patients were neonate (10.3%), 19 were under one year and 33 over one year. The frequent localization of abscess were: perianal; (n=18), submandibular; (n=6), axillar; (n=4), cervical; (n=3). Other localizations were mammary, gluteal region, upper extremities and periauricular region (n=25). Mainly local (n=56, 96%) anesthesia was used. Ampirical antibiotic was initiated and changed if necessary according to the bacterial growth (BG). No major complication was observed. BG demonstrated on bacterial culture of 45 of 58 admission (77%). In 15.5% (n=7) of cultured abscesses grew aerobes and 4.4% (n=2) anaerobes exclusively. 44.4% (n=20) grew a mixture of aerobes and anaerobes. 33.3% (n=15) grew a mixture of aerobes and aerobes. It has been only one growth on mycobacterium tuberculosis. Predominant aerobic organisms were Enterobacter (n=16, 17.5%), S. Aureus(n=15, 16.4%), Enterococcus (n=15, 16.4%), E. Coli (n=13,14,2%) and predominant anaerobic organism was Propionibacterium acnes (n=7, 7.7%). Enterobacter and E. Coli have susceptibility against to sefaperazon-sulbactam and all S. Aureus susceptible to meticillin. S. Aureus and Enteroccocus are sensible to ampicillin-sulbactam and amoxicillin-clavulonic acid. Conclusion: 1. The frequent localization of abscesses was perianal, submandibular and axillar. 2. Local anesthesia was the preferred method for abscess incision and drainage. 3. No differences have observed between different age groups on localization and complication of abscesses. 4. Aerobic and anaerobic culture should be done to find out the antibiotic susceptibility. Introduction Percutaneous abscess drainage is a frequent procedure in the pediatric surgery outpatient setting (1,2). As seen as a simple procedures, the treatment and follow-up protocols are not standardized and overlooked. Additionally the organisms responsible for abscesses can differ in each institution (3,4). The aim of the study is to document the patients with abscess who had been treated surgically in our pediatric surgery outpatient setting. Material And Methods Within 2.5 year period, we investigated the total admissions, patients with abscess, their register cards, age distribution, abscess localization, complications, bacterial growth in the abscess materials, anaerobic and aerobic bacteria and susceptibility of bacteria retrospectively. Results Between January 1999-April 2001, total outpatient admission was 6127 patients. Among this admission patients with abscess consists of 58 (0.94%) patients. Mean age was 3.5 years (11days-15years). Age distribution: Neonate (n=6), 1 month-1 year (n=19) and >1 year (n=33). The frequent localization of abscess was perianal and the frequent growing microorganisms were Enterobacter, S. Aureus and Enterococcus (Table 1). Local (n=56) and general (n=2) anesthesia were used for abscess drainage. Following incision and drainage empirical antibiotics were initiated and changed if necessary according to the bacterial growth (BG). Average dressing was 1.3 days and varied with size and location. No major complication was observed in the follow-up. BG demonstrated on bacterial cultur of 45 of 58 admission (77%). Specimens from abscesses were cultured for aerobic and anaerobic microorganisms. These ba