Perianal Infection Research Articles

Comparison of different concentrations of a povidone iodine-diluted sitz bath in the prevention of perianal infection in patients undergoing chemotherapy for hematological malignancy: study protocol for a randomized controlled trial

BackgroundInfection is one of the most common causes of death in patients with hematological malignancies during chemotherapy. Due to its special location, local warmth and humidity, repeated pollution with stool and urine, and characteristically wrinkled anatomical structure within which bacteria can hide, the perianal becomes a site with a high incidence of infection. Such infection also has a high recurrence rate and high mortality, increasing the economic burden of patients, delaying the time of treatment and reducing the quality of life. In severe cases, sepsis occurs and endangers the patient’s life. Previous studies have confirmed the effectiveness of povidone iodine (PI) in the prevention of perianal infection in patients with hematological malignancies during chemotherapy, but these reports have not documented in detail the adverse events associated with sitz bathing and the lack of randomized controlled trials of different concentrations of dilute povidone iodine sitz bathing. Therefore, the evidence is insufficient. Hence, the objective of this paper is to determine whether a povidone iodine diluent sitz bath can reduce the incidence of perianal infection compared with conventional perianal cleaning care and to observe the incidence of perianal infection, the severity of perianal infection, and the complications related to the sitz bath among groups treated with different concentrations of povidone iodine diluent, especially in high-risk patients prone to perianal infection, to screen for the optimal concentration.MethodsThe trial is designed as a single-center, parallel, randomized, controlled and intervention trial with four parallel groups, and a primary endpoint of perianal infection occurred after this hospitalization chemotherapy. Randomization will be performed as simple randomization with a 1:1:1:1 allocation. This study received full ethics committee approval. The first patient was enrolled on May 1, 2021. A total of 268 patients with hematological malignancies undergoing chemotherapy who have risk factors for perianal infection will be enrolled with informed consent and randomly allocated to one of the four arms receiving (1) perianal cleaning care (control group D), (2) 1:100 PI diluted sitz bath (intervention group A), (3) 1:200 PI diluted sitz bath (intervention group B), and (4) 1:300 PI diluted sitz bath (intervention group C). The primary endpoint of the trial was the incidence of perianal infection. The secondary endpoints of the study will be the results of anal swab bacterial culture, the severity of perianal infection, the incidence of perianal adverse events (dryness, peeling, pigmentation, burning sensation), and pain scores. The length of hospitalization in days and hospitalization expenses will be recorded. Safety will be assessed with consideration of all adverse and severe adverse events related to the study treatment.DiscussionWe hypothesized that patients with hematological malignancies during chemotherapy would benefit from a povidone iodine diluted sitz bath. This study will provide evidence-based recommendations for clinicians and nurses.Trial registrationChinese Clinical Trial Registry (registration ID: ChiCTR2000041073). Registered on December 17, 2020. The protocol version number is V1.0,20201217. http://www.chictr.org.cn/edit.aspx?pid=66044&htm=4

Active Screening of Intestinal Colonization of Carbapenem-Resistant Enterobacteriaceae for Subsequent Bloodstream Infection in Allogeneic Hematopoietic Stem Cell Transplantation.

PurposeTo investigate the prevalence, risk factors of intestinal carbapenem-resistant Enterobacteriaceae (CRE) colonization and bloodstream infection (BSI) caused by CRE in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients.MethodsWe analyzed the clinical data of 185 patients with hematological malignancies who underwent allo-HSCT from May 2019 to December 2021. All patients received regular CRE monitoring by rectal swab during allo-HSCT, and some CRE strains were further identified for carbapenemase phenotypes. The rates, distribution and risk factors of CRE colonization, CRE-induced BSI were analyzed.ResultsCRE was detected in 44 of 185 recipients, with colonization rate of 23.8%. A total of 46 strains of CRE were isolated, including 22 Escherichia coli, 17 Klebsiella pneumoniae, three Klebsiella oxytoca, two Enterobacter hormaechei, and two other Enterobacteriaceae. Among the 19 strains identified with carbapenemase phenotypes, eight strains of E. coli produced metal β-lactamase, five K. pneumoniae produced serine carbapenemase, two K. pneumoniae produced metal β-lactamase, two K. oxytoca produced metal β-lactamase, a Citrobacter malonic acid-free produced metal β-lactamase and a Citrobacter freundii produced metal β-lactamase. In 10 patients developed with CRE-related BSI, the types and combined drug sensitivity of strains detected by rectal swab were highly consistent with blood culture. Multivariate analysis revealed that pulmonary infection, perianal infection and carbapenem application in the 3 months pre-transplant were independent risk factors for rectal CRE colonization, while rectal colonization with carbapenem-resistant K. pneumoniae (CR-KP) was an independent risk factor for CRE-induced BSI. The mortality rate within 30 days of CRE-related BSI was 50.0%, and patients receiving multi-drug therapy within 24 hours showed slightly lower mortality than that in the single-drug treatment group.ConclusionAllo-HSCT patients with CRE-induced BSI have poor prognosis, and CR-KP rectal colonization is an independent risk factor for CRE-related BSI. Rectal swab screening during allo-HSCT could provide early warning for later CRE-induced BSI.

Multifunctional all-in-one adhesive hydrogel for the treatment of perianal infectious wounds.

Postoperative wound of perianal infectious disease represents a common but unique refractory wound in clinical practice. The reasons that hinder the wound healing process include not only the severe bacterial infection of the wound itself and the narrow and deep shape of the wound, but also its frequent bacterial contact. Therefore, the development of biofunctional dressings to aid in therapy is essential. In this study, we synthesized a new type of dressing comprising a hydrogel host based on the Schiff base principle and catechol groups between polydopamine, oxidized dextran, and quaternized chitosan, and then loaded it with traditional Chinese medicine molecules. These formed an integrated hydrogel for accelerated wound repair in a perianal infection model. The prepared hydrogels exhibited excellent wet tissue adhesion, antifouling, morphological variability, suitable swelling properties, and complete degradability, as well as remarkable contact antibacterial ability and the ability to rapidly scavenge free radicals. Hemostatic experiments showed excellent hemostatic properties, as the integrated hydrogel could instantly gel to seal the hemorrhage. Hemocompatibility and in vitro cell experiments showed that the integrated hydrogel had good biosafety and significantly promoted cell proliferation, which in turn accelerated the repair of infected whole cortexes in rats. A histomorphological evaluation showed that the integrated hydrogel promoted the recovery of normal anatomical tissue in rats by promoting the formation of collagen fibers and inhibiting inflammation. The results showed that this multifunctional integrated hydrogel has great potential for the treatment of continuously infected skin regeneration, providing a promising therapeutic strategy for postoperative wound healing in perianal infectious diseases.

The Role of White Blood Cell Count in Perianal Pathologies: A Retrospective Analysis of Hematologic Malignancies.

Background and ObjectiveInfections are the most common cause of anal and perianal pathologies in patients with hematological malignancies. Perianal infection diagnosis in this group of patients is difficult; thus, a careful anorectal examination is necessary with imaging modalities. In addition, the literature reveals a knowledge gap in the approach to anal pathologies in patients with neutropenia during diagnosis or chemotherapy. This study aimed to examine our institutional data on perianal complications and investigate the relationship between the white blood cell-neutrophil count, perianal lesion, and the type of treatment in patients with hematologic malignancies during the neutropenic period.MethodsPatients with a hematologic malignancy, hospitalized for cytotoxic chemotherapy, complicated by perianal pathology, documented by at least one imaging method, were included in the study.ResultsA total of 42 patients were included in the study. Most of them had acute leukemia, 31 were affected by acute myeloid leukemia (AML), and 7 by Acute lymphoid leukemia (ALL). There was no statistically significant relationship between the anal abscess formation, the neutrophil count, and a previous perianal pathology. Anal abscess development was significantly more frequent in acute myeloid leukemia. An inverse relationship was found between the total white blood cell number at onset and having a surgical intervention for anal pathology.In conclusion, this article has shown that white blood cell count at the time of hospitalization can affect the surgical intervention in patients with hematological malignancy (in the majority with acute leukemia) affected by anal pathologies occurring in the neutropenic period.

P1575: DEVELOPMENT OF A RISK PREDICTION MODEL OF SUBSEQUENT BLOOLDSTREAM INFECTION AFTER CARBAPENEM-RESISTANT ENTEROBACTERIACEASE ISOLATED FROM PERIANAL SWABS IN PATIENTS WITH HEMATOLOGICAL DISEASES

Background: Hematological patients are at higher risk of developing carbapenem-resistant Enterobacteriaceae (CRE) bloodstream infection (BSI) and associated with high mortality. Prediction model for a subsequent CRE BSI in hematological patients with CRE isolated from previous perianal swab samples can provide timely and useful target treatment strategies. Aims: To developing a quantified risk prediction model based on the risk factors of subsequent BSI in CRE carriers will help clinicians better identify specific individuals who would truly benefit from early, empiric CRE-targeted treatment. Methods: The data were extracted from patients with CRE isolated from perianal swab samples at the Hematopoietic Stem Cell Transplantation Center of Blood Diseases Hospital, Chinese Academy of Medical Sciences between July 2017 to October 2020 January. Patients who developed subsequent CRE BSI were compared with those who did not develop BSI. Univariate logistic analysis, multivariate logistic analysis and stepwise regression analysis were carried on a variety of clinical factors. Results: A total of 215 cases were included and 29 (13.4%) patients of them with CRE isolated from perianal swab samples developed CRE BSI subsequently. Multivariate analysis showed that C-reactive protein(CRP)﹥30mg/l(OR 10.613，95%CI 2.965~37.985，P=0.000）, perianal infection(OR 6.450, 95%CI 2.223~18.714, P=0.001), concomitant gastrointestinal symptoms (OR 4.175，95%CI 1.476~11.813，P=0.007），age﹥44 years (OR 3.415，95%CI 1.222~9.541，P=0.007）and neutrophil count﹤0.025×109/L (OR 4.583，95%CI 0.939~22.369，P=0.060）were risk factors for CRE BSI in patients with CRE isolated from perianal swab samples (P<0.01). They were included in the Logistic regression model to predict BSI. According to receiver operating characteristic (ROC) curve analysis, the cut-off value of the model was 0.921 (0.851-0.968，P<0.001). Image:Summary/Conclusion: Hematological patients with CRE isolated from perianal swab samples have a relatively low incidence of subsequent BSI but a relatively high risk of death. The risk prediction model based on CRP, perianal infection, concomitant gastrointestinal symptoms, age and valley absolute neutrophil may be used for predicting subsequent CRE BSI in patients with isolated from perianal swab samples and provide timely and effective treatment reference for this kind of patients.

PB2278: INVESTIGATION ON THE STATUS OF INFECTION IN PATIENTS WITH MULTIPLE MYELOMA

Background: multiple myeloma; infection; clinical features; predisposing factors Aims: To preliminarily explore the clinical features, distribution of infection sites and susceptibility factors of infection in patients with multiple myeloma. Methods: he clinical data of 505 patients with multiple myeloma who were treated in our hospital from January 2015 to October 2021 were retrospectively analyzed, and they were divided into infection group and control group according to whether infection occurred. The baseline data, clinical characteristics, infection site, and blood biochemical indexes during infection were collected and analyzed. Results: Among the 505 patients, 109 patients had infection, and the infection rate was about 21.6%. Lung was the main infection site in 53 cases, followed by 6 cases of urinary system infection, 3 cases of skin infection, 2 cases of perianal infection, and 45 cases with no clear infection foci. In the distribution of pathogenic bacteria, a total of 13 gram-negative bacteria, 9 gram-positive bacteria, 13 fungi and 1 virus were detected. Males and patients with education below high school were more susceptible to infection (P<0.05). Summary/Conclusion: The incidence of infection in patients with multiple myeloma is about 21.6%. The lung is the main infection site, and gram-negative bacteria are the main infection bacteria. Male and low education are the susceptibility factors for infection.

Применение препарата Грандазол для профилактики и лечения гнойных инфекций в колоректальной хирургии

В статье приведены материалы по изучению применения комбинированного препарата Грандазол в сравнении с раздельным использованием левофлоксацина и орнигила для лечения гнойной патологии параректальной области и профилактики инфекционных осложнений в раннем послеоперационном периоде у колопроктологических больных, перенесших абдоминальные оперативные вмешательства. Проанализирована эффективность препарата Грандазол у 122 пациентов. Результаты исследования свидетельствуют о высокой антибактериальной эффективности, возможности использования препарата Грандазол в качестве препарата выбора для лечения гнойных инфекций перианальной области и профилактики инфекционных осложнений у колопроктологических больных, перенесших полостные оперативные вмешательства.

Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier's Gangrene Leading to Mortality and Irreversible Organ Damage.

The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. This article presents a case series of perianal infection progressing to Fournier's gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author's knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23-52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3-17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.

Temporary diverting end-colostomy in critically Ill children with severe perianal wound infection

Temporary diverting end-colostomy in critically Ill children with severe perianal wound infection

Broken beer bottle as a cause of sigmoid perforation: A summary of causes and predictors in the management of traumatic and non-traumatic colorectal perforation.

Introduction and importanceThe presence of foreign bodies at the colorectal level and associated complications is a problem that has become increasingly common in emergency departments. This condition carries high health costs, in addition to having high morbidity and mortality rates, due to the large number of complications such as perforation.Case presentation46-year-old male patient, who came to the emergency department of a low-level hospital with a clinical picture of approximately one day of evolution consisting of the violent introduction of a foreign body (bottle) at the anorectal level secondary to aggression in a fight, with subsequent endoluminal rupture.Clinical discussionThe most recent evidence indicates that the incidence of perforation as a complication of colorectal foreign body introduction is low. However, the presence of profuse bleeding, advanced age, presence of comorbidities and sepsis are predictors of poor prognosis in these cases. In general, perforation secondary to non-traumatic causes is more frequent, being predominantly due to colorectal cancer, ischemia, diverticulitis, inflammatory bowel disease, inadequate use of enema, iatrogenic endoscopy or anorectal manometry or fecal impaction. The presence of unfavorable factors prolongs hospital stay, the risk of reoperation, perianal infection, peritonitis, sepsis and wound infection, generating mortality rates of up to 38%.ConclusionColorectal perforation is more frequent in non-traumatic situations and carries health costs and risk of mortality. Its management depends on hospital aspects, clinical context of the patient and training of health personnel. However, most of the outcomes are favorable.

Long-term outcomes after seton placement for perianal fistulas with and without Crohn's disease.

Perianal sepsis in Crohn's disease (CD) fistulas is managed with antibiotics and surgical drainage; a noncutting seton is used for an identified transsphincteric fistula tract. The optimal management following seton placement for initial control of perianal sepsis remains to be determined. Our main aim was to assess the success rates of curative surgery, seton removal or long-term indwelling seton in patients with and without CD. This was a retrospective cohort of consecutive patients with a perianal fistula treated with a noncutting seton between 2010 and 2019, including 83 CD patients and 94 patients without CD. Initial control of symptomatic perianal infection with a seton and subsequent healing and reintervention rates were compared between the three postseton management strategies. A total of 177 patients, 61% male and 83.1% with complex fistulas, were followed for a median of 23months (interquartile range 11-40months). Immunomodulatory treatment was used in 90.4% of CD patients after seton placement. Good initial control of perianal infection was achieved with a seton in CD and non-CD patients, at 92.9% and 96.7%, respectively (p=0.11). Overall fistula healing or control for CD and non-CD patients was, respectively, 64% and 86% (p=0.1) after curative surgery, 49% and 71% after seton removal (p=0.21) and 58% and 50% with long-term seton placement (p=0.72). Overall reintervention for recurrence was 83% in CD versus 53.1% in non-CD patients during the follow-up period (p=0.002). Definitive surgery was possible in only a minority of CD patients. Long-term seton management was an effective option in patients with CD with acceptable improvement and recurrence rates.

Efficacy of transanal hand-sewn reinforcement in low rectal stapled anastomosis in preventing anastomotic leak after transanal total mesorectal excision

Objective: To explore the efficacy and feasibility of transanal hand-sewn reinforcement of low stapled anastomosis in preventing anastomotic leak after transanal total mesorectal excision (taTME). Methods: A descriptive cohort study was conducted. Clinical data of 51 patients with rectal cancer who underwent taTME with transanal hand-sewn reinforcement of low stapled anastomosis at Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were retrospectively collected. Inclusion criteria: (1) age >18 years old; (2) rectal cancer confirmed by preoperative pathology; (3) distance from tumor to anal verge ≤ 8 cm according to pelvic MR; (4) the lesion was evaluated to be resectable before operation; (5) with or without neoadjuvant chemotherapy and radiotherapy; (6) taTME, end-to-end stapled anastomosis, and reinforcement in the anastomosis with absorbable thread intermittently were performed, and the distance between anastomosis and anal verge was ≤ 5 cm. Exclusion criteria: (1) previous history of colorectal cancer surgery; (2) emergency surgery due to intestinal obstruction, bleeding or perforation; (3) patients with local recurrence or distant metastasis; (4) the period of postoperative follow-up less than 3 months. The procedure of transanal hand-sewn reinforcement was as follows: firstly, no sign of bleeding was confirmed after checking the anastomosis. Then, the anastomosis was reinforced by suturing the muscle layer of rectum intermittently in a figure-of-eight manner using 3-0 single Vicryl. The entry site of the next suture was close next to the exit site of the last one. Any weak point of the anastomosis could also be reinforced according to the specimen from the circular stapler. The primary outcome were the incidence of anastomotic leak, methods of the secondary operation, anastomotic infection, anastomotic stricture, and conditions of Intraoperative and postoperative. Results: All the 51 enrolled patients completed surgery successfully without any conversion to open surgery. The median operative time was 169 (109-337) minutes, and the median intraoperative blood loss was 50 (10-600) ml. The median postoperative hospital stay was 8 (5-16) days. The mssorectum was complete and distal resection margin was negative in all patients. Postive circumferential resection margin was observed in 1 patients (2.0%). Twelve (23.5%) patients underwent prophylactic ileostomy. One patient developed anastomosis stricture which was cured by digital dilatation of the anastomosis. ISREC grade C anastomotic leak was observed in 3 (5.9%) male patients, of whom 2 cases did not received prophylactic ileostomy during the operation, and were cured by a second operation with the ileostomy and anastomotic repair. The other one healed by transanal repair of the anastomosis and anti-infection therapy. One (2.0%) patient suffered from perianal infection and healed by sitz bath and anti-infection therapy. No death was reported within 30 days after operation. Conclusion: Transanal hand-sewn reinforcement in low rectal stapled anastomosis in preventing anastomotic leak after taTME is safe and feasible.

Leukocyte Adhesion Deficiency-I (LAD-I): A Comprehensive Review of Published Cases

LAD-I is a rare disorder of leukocyte adhesion, resulting from ITGB2 gene mutations encoding for the Beta-2 Integrin component CD18. CD18 deficiencies prevent integrin dimerization and endothelial leukocyte adhesion, essential for extravasation and antimicrobial activity. LAD-I is characterized by delayed separation,of the umbilical cord, omphalitis, poor wound healing and leukocytosis. Severe LAD-I (<2% of normal neutrophil [PMN] CD18 levels) is characterized by recurrent serious infections and early mortality unless treated by allogeneic haematopoietic stem cell transplant (HSCT). Mortality for severe LAD-I was reported as 75% by age 2 in an initial 1988 multicenter retrospective study. Moderate LAD-I (2-30% of PMN CD18 levels) is more indolent; although most pts survive childhood with recurrent skin and mucosal surface infections, mortality by age 40 can exceed 50%.Reports regarding LAD-I have been published in recent decades but no recent comprehensive prognostic assessments are available. We sought an updated understanding of severe LAD-I with emphasis on prognosis in the absence of HSCT, HSCT outcomes and association of CD18 expression with clinical features. We created a database of all published LAD-I cases via Pubmed searches and review of available references.Three hundred thirty LAD-I cases were reported between 1975-2017 in 111 publications (89 case-reports; largest series n=36). The nations reporting the most cases were Iran (n=64), USA (n=52), and India (n=45); the highest number of publications were from US centers (26). 113 pts were considered to have severe LAD-I, 63 moderate and 154 were not classified. PMN CD18 expression levels was reported for 270 cases and was <2% in 138 patients (51%) and ≥2% in 132 pts. Four pts with CD18 >2% were considered to have severe LAD-I (CD18% range 2.4 - 17.3). Gender was noted for 289 pts; 153 (53%) were male. Age at presentation was reported for 152 cases. For 65 pts with CD18<2%, median presentation was age 1 m (range 0.03-18m); for 64 pts with CD18 ≥2%, median presentation was age 6m (range 0.03-192m).We sought to understand whether prognosis for severe LAD-I in the absence of HSCT is similar to the initially-reported 25% survival to age 2. There were 59 severe LAD-I cases (per investigator assessment or CD18 <2%) for whom survival to 2 years was reported, 38 of whom died prior to age 2 (64% mortality). Mortality was similar for the subset of 43 cases reported since 2000 (58%, 25 deaths). Early mortality was substantially lower in patients with CD18 ≥2% and the majority of pts with CD18 >4% survived to adulthood. Outcomes for 119 pts who received HSCT were consistent with recent series; phenotypic correction was reported in 85% of pts with HLA-matched sibling donors. Mortality was 15% overall (8% for HLA-matched sibling recipients). The 27 pts receiving haploidentical HSCT had frequent graft failure (33%) with 16 (59%) receiving ≥1 subsequent HSCT.Infection details and CD18% were available for 159 (48%) cases. The most frequent infections in pts with CD18 <2% were respiratory tract (39%), sepsis (28%) and otitis media (27%) and for pts with CD18 ≥2% they were periodontal (51%), otitis media (35%) and sepsis (25%). Perianal skin infections and necrotic skin ulcers were noted in >10%. Umbilical complications were more frequent in severe LAD-I (94 of 112 pts with CD18<2% [84%] and 49 of 83 with CD18 ≥2% [59%; p = 0.0001]). For severe LAD-I pts with ≥2 years of follow-up (or death prior to 2y), there was correlation between absence of umbilical complications and survival to 24 m (p < 0.001). WBCs were reported in 149 cases (median 45 x 109/L; range 10 - 150 x 109/L) (normal range 4.5 to 11 × 109/L).There were limited correlations between CD18 expression and WBC (r < 0.1) and between CD18 and CD11 expression (r < 0.5).Severe LAD-I remains a life-threatening condition with limited 2-year survival in the absence of allogeneic HSCT. Umbilical complications and granulocytosis occur in nearly all pts. Respiratory tract, ear, sepsis, oral and skin infections are common. HSCT is potentially curative; transplant-mortality and other complications are frequent, especially in haploidentical transplants. Rapid identification of pts with potential LAD-I (unusual or severe infections in infancy, granulocytosis and umbilical complications) is essential to enable referral to centers with disease expertise. DisclosuresThrasher:4bio Ventures Management Ltd: Other: Advisory Board; Orchard Therapeutics: Consultancy; Rocket Pharmaceuticals Ltd: Consultancy; Torus Therapeutics, Inc: Other: Advisory Board. Kohn:BioMarin Pharmaceutical: Research Funding; Orchard Therapeutics Ltd.: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kite Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Biogen IDEC: Research Funding.

Perianal disease remains an understudied and difficult complication in leukemia patients.

e19016 Background: Perianal infection is a rare and poorly understood complication of patients with acute myeloid/lymphocytic leukemia (AML/ALL). With the advancements in oncology, patients are living longer in an immunocompromised state and thus bearing the inherent problems such as infections that arise with it. Perianal infection and its management impacts patients' quality of life as well as interrupts their ongoing oncologic treatment. The optimal treatment strategy for perianal infections in this highly immunocompromised group remains unclear, as does the selection and outcomes of patients for operative intervention. The aim of this study is to identify patient characteristics associated with perianal infection and to delineate outcomes in patients that undergo operative intervention. Methods: The National Inpatient Sample (NIS) database was used to identify hospitalized patients with diagnoses of perianal abscess and AML/ALL between 2007 and 2015. Patient data were weighted to obtain national estimates. Demographics and clinical characteristics were compared between patients with and without perianal disease using Rao-Scott Chi-square test for categorical variables, and weighted simple linear regression for continuous variables. Characteristics and outcomes were compared between patients who underwent operative or non-operative management. Results: There were 12,626 (0.7%) patients with perianal disease among 1,782,778 AML/ALL patient admissions. Patients with perianal disease were more likely to be younger (43.9 (42.5 – 45.3) years, p &lt; 0.001), male (67.4% vs 32.6%, p &lt; 0.001) and white (65.8% vs 54.8%, p &lt; 0.001). Length of stay (18.4 days vs 9 days, p &lt; 0.001) and hospital cost ($54K vs $25K, p &lt; 0.001) were higher in those with perianal disease, but there was no difference in in-hospital mortality (5.5% in those with perianal diseases vs 6.2% in those without, p = 0.150). Greater proportion of patients without perianal disease were discharged to hospice (12.6% patients without perianal disease vs 5.1% patients with perianal disease, p &lt; 0.001). Receiving a surgical intervention did not improve outcomes with respect to in-hospital mortality (5.9% operative vs 5.4 non-operative, p = 0.596), length of stay (20.2 days vs 18.2 days, p = 0.582) or hospital cost ($67K vs $53K, p = 0.525). Conclusions: Perianal disease is a rare but distressing complication in AML/ALL patients associated with longer hospital stays and higher hospital costs. Operative intervention for perianal disease did not reduce rates of in-hospital mortality, length of stay or hospital cost but it does impact the probability of discharge to hospice. Non-operative and operative intervention both remain equivocal in changing the outcomes these patients. Further studies are required to examine these associations and determine best practices for treatment of this condition in this complex patient population.

Recurrent Anal Abscess in a Young Male Patient with Autosomal-Dominant Hyper IgE Syndrome

Here we present the case of a 17-year-old male patient affected by autosomal-dominant Hyper IgE Syndrome (AD-HIES) who underwent to incision and drainage of recurrent anterior anal abscess. To our knowledge, this is the first reported case about recurrent perianal infection in autosomal-dominant Hyper IgE Syndrome.

Fistula-Related Cancer in Crohn’s Disease: A Systematic Review

Simple SummaryCancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease. The relationship between perianal fistula in CD (Chron’s disease) and SCC (squamous cell carcinoma) development is not clear but chronic inflammation of ano-rectal mucosa, delayed wound healing and cell turnover may play important roles. The aim of this systematic review was to determine the clinical characteristics of patients with squamous cell carcinoma arising from perianal fistula in CD, the surgery and oncological treatment, the role of HPV infection, immunosuppression and the survival of these patients. Fistula-related carcinoma in CD can be very difficult to diagnose. An early diagnosis has the potential to improve the outcome of disease.Perianal fistulizing Crohn’s disease is a very disabling condition with poor quality of life. Patients with perianal fistulizing Crohn’s disease are also at risk of perianal fistula-related squamous cell carcinoma (SCC). Cancer arising at the site of a chronic perianal fistula is rare in patients with Crohn’s disease and there is a paucity of data regarding its incidence, diagnosis and management. A systematic review of the literature was undertaken using Medline, Embase, Pubmed, Cochrane and Web of Science. Several small series have described sporadic cases with perianal cancer in Crohn’s disease. The incidence rate of SCC related to perianal fistula was very low (<1%). Prognosis was poor. Colorectal disease, chronic perianal disease and HPV infection were possible risk factors. Fistula-related carcinoma in CD (Chron’s disease) can be very difficult to diagnose. Examination may be limited by pain, strictures and induration of the perianal tissues. HPV is an important risk factor with a particular carcinogenesis mechanism. MRI can help clinicians in diagnosis. Examination under anesthesia is highly recommended when findings, a change in symptoms, or simply long-standing disease in the perineum are present. Future studies are needed to understand the role of HPV vaccination in preventing fistula-related cancer.

Perianal streptococcal disease in childhood: systematic literature review

Group A Streptococcus has been associated with a perianal infection. We conducted a systematic review of the literature on childhood streptococcal perianitis in three databases: Excerpta Medica, National Library of Medicine, and Web of Science. The main purposes were to document the clinical features, the tendency to recur, the association with an asymptomatic streptococcal throat carriage, the accuracy of rapid streptococcal tests, and the mechanism possibly underlying the acquisition of this infection. More than 80% of cases are boys ≤7.0 years of age with defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness. Perianitis is associated with a streptococcal tonsillopharyngitis in about every fifth case. The time to diagnosis is ≥3 weeks in 65% of cases. Recurrences occur within 3½ months in about 20% of cases. An asymptomatic group A streptococcal throat carriage occurs in 63% of cases. As compared with perianal Streptococcus A culture, the rapid streptococcal tests have a positive predictive value of 80% and a negative predictive value of 96%. It is hypothesized that digital inoculation from nasopharynx to anus underlies perianitis. Many cases are likely caused directly by children, who are throat and nasal carriers of Streptococcus A. Some cases might occur in children, who have their bottoms wiped by caregivers with streptococcal tonsillopharyngitis or carriage of Streptococcus.Conclusion: Perianitis is an infection with a distinctive presentation and a rather long time to diagnosis. There is a need for a wider awareness of this condition among healthcare professionals.What is Known:• Group A Streptococcus may cause perianitis in childhood.• Systemic antimicrobials (penicillin V, amoxycillin, or cefuroxime) are superior to topical treatment.What is New:• The clinical presentation is distinctive (defecation disorders, perianal pain, local itch, rectal bleeding, or fissure and a sharply demarcated perianal redness).• The time to diagnosis is usually ≥3 weeks.Recurrences occur in about 20% of cases.

Microsatellite Instability in Gastrointestinal Cancer Using Deep Learning: A Review

Currently, the health management is a foremost concern all over the world. Particularly in India, due to lack of physical activity, overweight, stress and unhealthy eating habits, various diseases like heart disease, diabetes and cancer disease are increasing at a very rapid rate. The common problem which is affecting all age generation is a gastrointestinal disorder which includes various conditions like colitis, colon polyps, perianal infection and cancer. Microsatellite Instability (MSI) in gastrointestinal (GI) cancer is the second leading cause of death worldwide. However, this cancer can frequently be asymptomatic during the early stages and stay undetected until the later stages of tumor advancement. Deep Learning has the capacity to detect MSI in gastrointestinal cancer at an early stage, which is very helpful for the patients. There are number of research papers, focusing on different techniques used for detection of MSI in gastrointestinal caner. In this paper, we focus on the recent trends of deep learning methods in this field. The main goal of this review paper is to provide a detailed discussion from technological perspective. This article discusses various challenges, molecular subtypes, pathologist approach and computer aided approach for gastrointestinal cancer detection. Also, this article brings into light the existing literature and state of art with their contribution in different aspects of detection of microsatellite instability in gastrointestinal tract with the help of deep learning techniques.

Risk Factors and Outcomes of Antibiotic-resistant Pseudomonas aeruginosa Bloodstream Infection in Adult Patients With Acute Leukemia.

Pseudomonas aeruginosa (PA) bloodstream infection (BSI) is a common complication in patients with acute leukemia (AL), and the prevalence of antibiotic-resistant strains poses a serious problem. However, there is limited information regarding antibiotic resistance, clinical characteristics, and outcomes of PA BSI in AL patients. This study explored characteristics associated with the clinical outcomes of AL patients with PA BSI and analyzed factors associated with BSI caused by multidrug-resistant (MDR) or carbapenem-resistant strains. This single-center retrospective study enrolled hospitalized AL patients who developed PA BSI during January 2014-December 2019. The Kaplan-Meier method was used to plot survival curves. Multivariate logistic regression analyses were also performed. Of 293 eligible patients with PA BSI, 55 (18.8%) received inappropriate empirical antibiotic therapy within 48 hours of BSI onset, whereas up to 65.8% MDR-PA BSI patients received inappropriate empirical treatment. The 30-day mortality rate was 8.5% for all patients. However, the 30-day mortality rates were 28.9% and 5.5% in MDR-PA BSI and non-MDR-PA BSI patients, respectively (P < .001). On multivariate analysis, previous use of quinolones (odds ratio [OR], 5.851 [95% confidence interval {CI}, 2.638-12.975]) and piperacillin/tazobactam (OR, 2.837 [95% CI, 1.151-6.994]) were independently associated with MDR-PA BSI; and MDR-PA BSI (OR, 7.196 [95% CI, 2.773-18.668]), perianal infection (OR, 4.079 [95% CI, 1.401-11.879]), pulmonary infection (OR, 3.028 [95% CI, 1.231-7.446]), and age ≥55 years (OR, 2.871 [95% CI, 1.057-7.799]) were independent risk factors for 30-day mortality. MDR increases mortality risk in PA BSI patients, and previous antibiotic exposure is important in MDR-PA BSI development. Rational antibiotic use based on local antimicrobial susceptibility and clinical characteristics can help reduce antibiotic resistance and mortality.

PERIANAL INFECTIOUS COMPLICATIONS IN PATIENTS WITH GRANULOCYTOPENIA AND HAEMATOLOGICAL MALIGNANCIES

AIM : to study the perianal infection (PI) in patients with granulocytopaenia (GCP) and hematological malignancies (HM). PATIENTS AND METHODS: the prospective study (2016-1018) includes 95 episodes of PI in 76 patients with HM (male/female 35/44; mean age of 35 (17-69)). 43(54.4%) of the patients were detected to develop acute leukemia (AML – 34 (43%); ALL – 9(11.4%); NHL – 17(21.5%). The comparison of PI episodes within the GCP period (number of granulocytes less than 0.5x10 9 /l) and without it was done. RESULTS: PI episodes within the period of GCP were significantly much more often than those without GCP (77.9% vs 22.1%, relative risk 3.5 (95% CI: 2.4-5.2). The biggest number of PI episodes in the setting of GCP was registered within the period of chemotherapy (ChT): in the phase of consolidation (28.4%) and induction (13.3%) of acute leukemia ChT and lymphomas’ ChT (20.3%). Anal fissures were the most frequent source of PI within GCP period (66.2% vs 19.1% without GCP, p&lt;0.001). Inflammatory changes in perianal tissues were clinical features of PI in the setting of GCP in 89.2% of the cases: inflammatory mass in 71.6% (vs 23.8% without GCP, p&lt;0.001), abscess in 8.1% (vs 66.7% without GCP, p&lt;0.001). In 10.8% of the cases of PI with GCP only perianal pain and fever were registered. No tissues change was detected with the lowest WBC count (Me 0.2 (0.1-0.5) x10 9 /l). Bloodstream infections were detected in 15 (20.3%) episodes within the period of GCP only, of them in 6 (8.1%) cases the species matching of microorganisms in blood and in rectum was noticed. Within the period of GCP antibacterial therapy was carried out in 98.6% of the cases: antibacterial therapy alone was applied in 87.8% of the episodes (vs 7.2% without GCP, p&lt;0.001); both antibacterial therapy and surgical treatment were carried out in 10.8% (vs 61.9% without GCP, p&lt;0.001) of the cases. Mean duration of antibiotic treatment of patients with GCP was drastically longer in the group of postoperative patients in comparison with the group of those who had conservative treatment (25.5 vs 15.1 days, p=0.05). Antimicrobial therapy within GCP period resulted into inflammation regress in 83.1% of the cases; abscess or fistula formation, hence surgical treatment in 13.8% of the cases; progression of infection in 3.1% of the cases. Increase of GCP duration up to 30 and more days is connected with bacteremia rate increase (12.5% vs 28%, p&lt;0.05); combinations of PI with other infections (25% vs 52%, p&lt;0.05); requirement of antimicrobial therapy modification (16.7% vs 40%, p&lt;0.05). CONCLUSION: GCP significantly raises risk of PI. PI that develops in the setting of GCP, is characterized by abnormal, often low clinical manifestations and high risk of sepsis. Invasion of microorganisms through affected tissue seals is the basic mechanism of perianalinfection within the period of GCP. Antibacterial therapy is the prior method of PI treatment in the settings of GCP; antibacterial therapy efficiency is 83.1%. Need for surgery in the period of GCP is associated with the infectious episode and antibacterial therapy duration increase. Lengthening of GCP is a negative predictor in PI treatment.