ANTIBACTERIAL COMPONENT IN THE COMPREHENSIVE SURGICAL TREATMENT FOR SACROCOCCYGEAL PILONIDAL CYSTS

Feleshtynskyi Ya. P., Balan I. H., Potochylova V. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Effective treatment of patients with sacrococcygeal pilonidal cysts includes several factors, one of which is bacterial environment of pilonidal cyst and surrounding tissues, which should be taken into account when planning and performing surgical treatment. The effectiveness of surgical treatment in case of radical surgery for pilonidal cyst excision depends on the probability of spreading the cyst content to the wound, its possible suppuration under favorable conditions. The data on pilonidal cysts microflora and antibacterial drugs effect make it possible to control the probability of postoperative wound suppuration. The study is aimed at the increase in efficiency of comprehensive surgical treatment for sacrococcygeal pilonidal cysts provided by metronidazole, which is imidazole derivative. A radical surgical treatment was performed in 112 patients with sacrococcygeal pilonidal cyst: (102 (91.1 %) men and 10 (8.9 %) women). To assess the effectiveness of antibacterial drugs application, the patients were distributed into two groups. In the main group, 56 patients (50 %) underwent radical surgery for sacrococcygeal pilonidal cyst, followed by administration of ciprofloxacin tablets in the postoperative period, at a dose of 500 mg twice a day, along with metronidazole at a dose of 500 mg. The duration of taking both drugs was 5 days. The comparison group included 56 (50 %) patients who underwent identical volume of surgical treatment, followed by administration of ciprofloxacin in tablets at a dose of 500 mg twice a day in the postoperative period; the duration of taking the drug was 5 days. Microbiological studies of pilonidal cysts content in patients of this group were not carried out. The presence of obligate anaerobic microbiota in combination with facultative anaerobic one was observed in all patients. When assessing the course of wound healing in the main group during the first 10 days of the postoperative period, suppuration of postoperative wound was detected in 1 patient (1.8 %) of the total number of 56 patients. In the comparison group, postoperative wound suppuration was observed in 5 patients (9 %), the presence of inflammatory infiltrate − in 3 patients (5.36 %) compared to 10 patients (17.8 %) in the comparison group. The most active drugs were carbapenems (imipenem, meropenem), vancomycin (glycopeptides). The study determined a high sensitivity to ciprofloxacin and metronidazole in patients. Given the synergistic antibacterial effect, provided by the simultaneous administration of metronidazole, which has a specific effect on anaerobic microflora and broad-spectrum antibiotics, this combination is rational. Involvement of this drug combination in the comprehensive surgical treatment provides better surgical treatment results, namely: a decrease in the frequency of both postoperative wound suppuration and occurrence of inflammatory infiltrate.

pilonidal cyst, coccygeal passage, anaerobic microbiota, metronidazole.

1. Mil’dzikhova DR, Sakaniya LR, Korsunskaya IM. Inversnye akne: abscediruyushchij i podryvayushchij follikulit i perifollikulit Goffmana. Klinicheskaya dermatologiya i venerologiya. 2018;17(4):110-3. [in Russiаn].
2. Sewon K, Masayuki A, Bruckner A, Enk A, Margolis D, Amy J, et al. Fitzpatrick’s Dermatology. Ninth Edition; 2019. р. 1483-4.
3. Scholz CF, Kilian M. The natural history of cutaneous propionibacteria, and reclassification of selected species within the genus Propionibacterium to the proposed novel genera Acidipropionibacterium gen. nov., Cutibacterium gen. nov and Pseudopropionibacterium gen nov. Int J Syst Evol Microbiol. 2016;66:4422-32.
4. Sorel Fitz-Gibbon, Shuta Tomida. Propionibacterium acnes Strain Populations in the Human Skin Microbiome Associated with Acne. Journal of investigative dermatology. 2013;133(9):2152-60. DOI: https://doi.org/10.1038/jid.2013.21
5. MacNiven I, Hsu J, Neradilek M, Matsen F. Preoperative Skin-Surface Cultures Can Help to Predict the Presence of Propionibacterium in Shoulder Arthroplasty Wounds. JBJS Open Access. 2018 March 29;3(1). DOI: 10.2106/JBJS.OA.17.00052
6. Webster GF, Ruggieri MR, McGinley KJ. Correlation of Propionibacterium acnes populations with the presence of triglycerides on nonhuman skin. Appl. Environ. Microbiol. 1981;41:1269-70.
7. Brook I. Microbiology of infected pilonidal sinuses. Journal of Clinical Pathology. 1989 Nov;42(11):1140-2. DOI: 10.1136/jcp.42.11.1140
8. Feleshtynskyj YaP, Balan IG. Optymizaciya chirurgichnogo likuvannya pilonidalnych kist kryzhovo-kuprykovoyi dilyanky. Chirurgiya Ukrayiny. 2019;4. DOI: https://doi.org/10.30978/SU2019-4-33 [in Ukrainian].
9. Feleshtynskyi YaP, Balan IH, vynakhidnyky. Sposib radykalnoho khirurhichnoho likuvannia pilonidalnoi kisty kryzhovo-kuprykovoi dilianky Patent Ukrayiny №139579 2020, № 1. [in Ukrainian].
10. Zubkov NM. Sbor, transportirovka biologicheskogo materiala i traktovka rezul’tatov mikrobiologicheskikh issledovanij. Klinich. mikrobiologiya i antimikrobnaya khimioterapiya. 2004;2:143. [in Russiаn].

«Bulletin of problems biology and medicine» Issue 4 (158), 2020 year, 205-208 pages, index UDK 6579.222:617.559

10.29254/2077-4214-2020-4-158-205-208