Significant presence of biofilm‐producing gut‐derived bacteria in anal fistula of chronic duration

Abstract

Fistula-in-ano though not a life-threatening condition, yet its symptoms often significantly impact patients' social, intimate, and work lives. There is an established role of bacterial microflora in acute infections. However, we proposed that biofilm-forming organisms might be present in the microflora of anal fistula of prolonged duration. This aspect has rarely been studied earlier.Therefore, the study describes the microbiology of anal fistula and the biofilmforming capacity of the isolated organisms. A total of 30 patients were included in the study as per the criteria. Anal fistula tissue sample, tissue fluid, and blood samples were collected from each individual. The collected specimens were detected for the presence of aerobic and anaerobic microflora through standard microbiological method and polymerase chain reaction. Furthermore, the role of biofilm formation by microtitre plate assay and serum matrix metalloproteinases-9 was also studied. The result showed significant predominance of gut-derived microflora with high-to-moderate biofilm-producing ability in anal fistulas of prolonged duration. The study emphasises the presence of biofilm-forming bacteria in chronic, non-healing fistula.

Perioperative Factors Affecting the Healing of Rectovaginal Fistula

“…and Prevotella spp. The authors made a similar hypothesis that patients with a fistula lasting more than 6 months had intestinal bacteria producing a thick layer of biofilm [61]. While the results of these studies cannot directly determine the contribution of biofilm-forming organisms to the progression of fistula infection, it would seem that in the case of a predominance of medium-to high-level biofilm-producing microflora, anal fistulae would heal poorly [60,61].…”

Effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula: A meta‐analysis

“…Anal fistula is a common condition in colorectal surgery 1 . Typically resulting from an infection of the anal glands, anal fistula is often challenging to treat due to the unique physiological and anatomical environment of the anal area, leading to recurring infections and persistent non‐healing 2 . High anal fistulas, located above the levator ani muscle and the anorectal ring, are especially prevalent in young and middle‐aged adults and are closely associated with dietary and lifestyle factors 3 .…”

“… 1 Typically resulting from an infection of the anal glands, anal fistula is often challenging to treat due to the unique physiological and anatomical environment of the anal area, leading to recurring infections and persistent non‐healing. 2 High anal fistulas, located above the levator ani muscle and the anorectal ring, are especially prevalent in young and middle‐aged adults and are closely associated with dietary and lifestyle factors. 3 These fistulas often involve the anal sphincter and lead to repeated infections, pain, discharge, anal itching, and scarring, causing significant discomfort and psychological stress to patients, making them among the more challenging colorectal conditions to manage.…”

Microbiomic signatures of anal fistula and putative sources of microbes

“…Similarly, many intestinal or skin microbiota, including biofilm-producing E. coli, Enterococcus spp., Bacteroides fragilis, Staphylococcus aureus, Klebsiella pneumoniae, Prevotella spp. and Streptococcus viridans, were isolated from stool samples or anorectal tissue samples in different perianal disease, such as inflammatory bowel disease (IBD), Crohn's disease (CD), anorectal abscess and anal fistula (Tozer et al, 2015;Sugrue et al, 2017;Dowling Enez and Izarra Henriquez, 2020;Jaiswal et al, 2021;Breton et al, 2022). In general, the infection of gut-derived microorganisms was shown to be closely related to the formation of anal fistula (Toyonaga et al, 2007;van Onkelen et al, 2013;Leach et al, 2021).…”