| Background: Perianal abscess is a common and frequently-occurring disease in anorectal department.At present,surgery is the main treatment method for perianal abscess.Multiple operations not only bring a certain economic burden to patients,but also the recovery process after surgery also has a great test for the patient’s mental and physical.In addition,post-operative complications,wound contamination,etc.are inevitable,so it has become a problem faced by anorectal physicians.For perianal abscess,mostly caused by bacterial infection,the application of antibiotics is also indispensable.However,Since several years,due to the irrational use of antibiotics,the resistance of pathogenic bacteria has increased,which has caused certain difficulties for clinicians to choose antibiotics.Numerous studies have shown that preoperative treatment of perianal abscess with traditional Chinese medicine can clear heat and detoxify,promote blood circulation and remove blood stasis,promote the subsidence of local inflammation,and have the effect of reducing swelling and relieving pain;postoperative use of traditional Chinese medicine is beneficial to smooth local qi and blood circulation,reduce wound pain and swelling,reduce bleeding,promote tissue repair,and shorten healing time.Although the conclusions of randomized controlled trials(RCTs)are considered to be high-level evidence-based basis,due to their own limitations,they cannot objectively and truly reflect clinical reality.Real world study refers to the collection and analysis of medical data in a real environment,generally without active intervention,and the evidence obtained in the research is more in line with clinical reality.Therefore,based on RWS analysis of pathogenic bacteria spectrum changes and drug resistance changes in perianal abscess,and research on Chinese medicine interventions,it will help to obtain high-level evidence-based medical evidence and rational use of antibacterial drugs in the perioperative period.Provide a reference basis for drugs,reduce the generation of drug-resistant strains,and explore the construction of new methods suitable for the evaluation of clinical efficacy of traditional Chinese medicine.Objective: Under real-world conditions,the distribution of pathogenic bacteria and drug susceptibility tests for perianal abscess were analyzed,common pathogenic bacteria and their sensitive antibiotics were mastered,and the basis for the selection of perioperative antibiotics was provided,and clinical Chinese medicine interventions were evaluated.It can provide reference for the clinical diagnosis and treatment of perianal abscess.Methods:Using the real world study model,retrospectively collected data of 350 patients with perianal abscess who were hospitalized and received surgical treatment in the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine,and Huaihua Traditional Chinese Medicine Hospital from January 1,2016 to December 31,2020 through the HIS.including: general information,diagnosis,doctor’s order records,laboratory test results,traditional Chinese medicine intervention,hospital days,wound healing,etc.After processing the collected data with Excel and establishing a database,SPSS23.0 statistical software was used to analyze the variability of related pathogens,and clinical data of the traditional Chinese medicine for the diagnosis and treatment of perianal abscess was analyzed and evaluated.Results:Among the 350 specimens,there were 34 cases of sterile growth,accounting for 9.71%(34/350);3 cases of fungal growth,accounting for 0.86%(3/350);313 cases of bacterial growth,accounting for 89.43%(313/350),of which There were 10 cases of multiple bacterial growth,accounting for 2.86%(10/350)considering the possibility of specimen contamination;303 cases of one bacterial growth,accounting for 86.57%.There were 274 cases of Gram-negative bacteria,accounting for 90.43%(274/303),including 188 cases of Escherichia coli,accounting for 62.05%(188/303);followed by58 cases of Klebsiella pneumoniae,accounting for 19.14%(58/303).There were 29 cases of Gram-positive bacteria,accounting for 9.57%(29/303),including 14 cases of Staphylococcus aureus,accounting for 4.62%.In the drug susceptibility test of Gramnegative bacteria,the drug resistance rate of ampicillin was the highest at 86.13%,followed by cefazolin with a drug resistance rate of 69.71%;The sensitivities of ropenem and tigecycline were relatively high;in the drug susceptibility test of Grampositive bacteria,the resistance rate of erythromycin was as high as 58.62%;for vancomycin,daptomycin,linezolid,teicoplanin,quinupristine/dalfopristin,meropenem and other drugs have higher sensitivity.59 strains of multidrug-resistant bacteria were isolated,accounting for 19.47%.The detection results of related pathogens in each year from 2016 to 2020 were compared and analyzed,P>0.05,there was no significant difference.All patients in this study were treated with traditional Chinese medicine after surgery,and the difference in the time required for wound healing between the traditional Chinese medicine treatment group and the integrated traditional Chinese and western medicine treatment group was compared and analyzed,and there was no statistical significance(P>0.05);During the follow-up,the recurrence rate in the TCM treatment group was 1.52%,and the recurrence rate in the TCM treatment group was 1.31%,P>0.05,which was not statistically significant,suggesting that there was no difference in the recurrence rate between the two groups.The cure rates of both the traditional Chinese medicine treatment group and the integrated traditional Chinese and western medicine treatment group were 100%,and there was no significant difference in clinical efficacy.Conclusion: In this study,Gram-negative bacteria are the main pathogens of perianal abscess.In clinical practice,sensitive antibiotics should be selected according to bacterial culture and drug sensitivity test to improve the therapeutic effect and reduce the generation of drug-resistant bacteria;from 2016 to 2020,the composition and distribution of pathogenic bacteria in perianal abscess abscess did not change significantly,indicating that the anorectal physicians in the above-mentioned hospitals paid more attention to the principles of clinical application of antibiotics and standardized the use of antibiotics;postoperative use of traditional Chinese medicine in patients with perianal abscessdiseases can promote wound healing and improve clinical efficacy. |
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