The Role of Wound Swab Microbial Cultures and Antibiotic Sensitivity Results in the Management of Sacrococcygeal Pilonidal Abscess

Abstract

Pilonidal sinus disease refers to a condition that affects approximately 0.7% of the population [1] where there is a small hole or tunnel in the skin often around the hair follicle in the natal cleft, forming a midline pit [2]. It can present acutely (or acutely recurrent within 6 weeks) where treatment involves draining the pus from the abscess or present as a chronic infection where the skin and tissues containing the sinus is removed. The condition, and treatment for pilonidal sinus often burden patients and caretakers with wound care and frequent visits to general practitioners (GPs) or hospital outpatient clinics [3]. For patients who present to hospitals with acute pilonidal abscess, the current practice is surgical drainage combined with antibiotic therapy. Wound swabs are routinely taken in the peri-operative period, and antibiotics are commonly initiated empirically pending culture and sensitivity results [2]. There are only a few studies that have reported observations on pilonidal abscess in the sacrococcygeal area, however, those studies that addressed superficial skin abscesses reported a limited role of wound culture results [4,5]. One study concluded that the use of postoperative antibiotics was guided by the patient's clinical picture, and that the microorganisms cultured were predictable, and sensitive to empirical antibiotics used in their institution [4]. The primary objective of this study was to determine the role of wound swabs in the management antibiotic therapy in patients with pilonidal abscess by analyzing the proportion of

Pilonidal sinus: an overview of historical and current management modalities

“…The predominant microorganisms identified in pilonidal abscesses include mixed anaerobic species (61.6%) followed by skin flora (20%). Notably, 13.4% of cases exhibit no microbial growth [ 12 ]. Metronidazole remains the classical choice for anaerobic coverage, while skin flora, predominantly comprised by streptococcus and staphylococcus, can be effectively addressed with a penicillin or a cephalosporin.…”

“…Specifically, there is no support for routine peri-operative antibiotics as a prophylaxis in patients with chronic disease. Except in some cases where there is only minor superficial skin infection and in cases of post operative residual cellulitis, where co-amoxiclav is the most commonly prescribed antibiotic [ 12 ], the current consensus is that there is no role for either standalone or perioperative use of antibiotics for the average patient [ 18 ].…”