Pilonidal Abscess Management: Microbiological Findings and Clinical Outcomes Following Empirical Cefuroxime–Ciprofloxacin Therapy

Yıl 2026, Cilt: 53 Sayı: 1, 151 - 158, 10.03.2026

Fırat Erkmen , Firuzan İdemen Mehmet Gerger Faik Tatlı

https://doi.org/10.5798/dicletip.1906471

https://izlik.org/JA69XB56XB

Öz

Objective: This study aimed to evaluate the microbiological profile and antibiotic susceptibility patterns in patients undergoing drainage for pilonidal sinus abscess and to assess the efficacy of an empirical cefuroxime-ciprofloxacin regimen.
Methods: Between November 2021 and February 2024, 88 patients who underwent drainage for pilonidal abscess at Balıklıgöl State Hospital and Harran University Faculty of Medicine Hospital were included. Pus cultures were obtained under sterile conditions. Patients received cefuroxime 500 mg (twice daily) and ciprofloxacin 500 mg (twice daily) postoperatively. Treatment success was defined as resolution of erythema and pain by day 7. Culture results and antibiograms were analyzed descriptively.
Results: İn the study included 63.6% of the patients were male (n=56), and 36.4% (n=32) were female. Staphylococcus (41.2%) and Streptococcus (31.4%) were the predominant isolates. Resistance to the empirical regimen occurred in 3 cases (3.4%), requiring escalation. The overall success rate was 96.6%. Culture negativity (42%) was noted but did not impact outcomes.
Conclusion: Pilonidal abscess microbiologically resembles skin/soft tissue infections. The cefuroxime-ciprofloxacin combination demonstrated high efficacy, though regional resistance patterns and anaerobic coverage merit further study.

Anahtar Kelimeler

Pilonidal abscess , culture , antibiogram , antibiotic resistance

Etik Beyan

The study protocol was approved by the decision of Harran University Faculty of Medicine Ethics Committee dated 18.03.2024 and numbered HRÜ/24.02.58.

Pilonidal Apse Tedavisi: Ampirik Sefuroksim-Siprofloksasin Tedavisi Sonrası Mikrobiyolojik Bulgular ve Klinik Sonuçlar

https://izlik.org/JA69XB56XB

Öz

Amaç: Bu çalışmada pilonidal sinüs apsesi nedeniyle drenaj uygulanan hastalarda mikrobiyolojik profil ve antibiyotik duyarlılık paternlerinin değerlendirilmesi ve ampirik sefuroksim-siprofloksasin rejiminin etkinliğinin değerlendirilmesi amaçlanmıştır.
Yöntemler: Kasım 2021 ile Şubat 2024 tarihleri arasında Balıklıgöl Devlet Hastanesi ve Harran Üniversitesi Tıp Fakültesi Hastanesi'nde pilonidal apse nedeniyle drenaj uygulanan 88 hasta çalışmaya dahil edildi. Apse kültürleri steril koşullar altında elde edildi. Hastalar postoperatif olarak sefuroksim 500 mg (günde iki kez) ve siprofloksasin 500 mg (günde iki kez) aldı. Tedavi başarısı eritem ve ağrının 7. güne kadar gerilemesi olarak tanımlandı. Kültür sonuçları ve antibiyogramlar tanımlayıcı olarak analiz edildi.
Sonuçlar: Çalışmaya dahil edilen hastaların %63,6'sı erkek (n=56), %36,4'ü (n=32) kadındı. Staphylococcus (41.2%) ve Streptococcus (31.4%) baskın izolatlardı. Ampirik rejime direnç 3 olguda (%3,4) görüldü ve yatış gerektirdi. Genel başarı oranı %96,6'dır. Kültür negatifliği (42%) kaydedilmiş ancak sonuçları etkilememiştir.
Sonuç: Pilonidal apse mikrobiyolojik olarak deri/yumuşak doku enfeksiyonlarına benzemektedir. Sefuroksim-siprofloksasin kombinasyonu yüksek etkinlik göstermiştir, ancak bölgesel direnç paternleri ve anaerobik kapsama daha fazla çalışmayı hak etmektedir.

Anahtar Kelimeler

Pilonidal apse , Kültür , Antibiogram , Antibiyotik direnci.

Kaynakça

• 1.Kanlioz M, Ekici U, Tatli F, Karatas T. PilonidalSinus Disease: An Analysis of the Factors AffectingRecurrence. Adv Skin Wound Care. 2021;34(2):81-5.
• 2.Jensen SL, Harling H. Prognosis after simpleincision and drainage for a first-episode acutepilonidal abscess. Br J Surg. 1988;75(1):60-1.
• 3.Harries RL, Alqallaf A, Torkington J, Harding KG.Management of sacrococcygeal pilonidal sinusdisease. Int Wound J. 2019;16(2):370-8.
• 4.Iesalnieks I, Ommer A, Herold A, Doll D. GermanNational Guideline on the management of pilonidaldisease: update 2020. Langenbecks Arch Surg.2021;406(8):2569-80.
• 5.Notaro JR. Management of recurrent pilonidaldisease, Semin Colon Rectal Surg 2003;14(4):173-85.
• 6.Hussain ZI, Aghahoseini A, Alexander D.Converting emergency pilonidal abscess into anelective procedure. Dis Colon Rectum.2012;55(6):640-5.
• 7.Lasithiotakis K, Aghahoseini A, Volanaki D, PeterM, Alexander D. Aspiration for acute pilonidalabscess-a cohort study. J Surg Res. 2018;223:123-7.
• 8.Matter I, Kunin J, Schein M, Eldar S. Total excisionversus non-resectional methods in the treatment ofacute and chronic pilonidal disease. Br J Surg.1995;82(6):752-3.
• 9.European Centre for Disease Prevention andControl. Antimicrobial resistance in the EU/EEA(EARS-Net)- Annual Epidemiological Report 2023.Stockholm: ECDC; 2024.
• 10.Khalil PN, Brand D, Siebeck M, et al. Aspirationand injection-based technique for incision anddrainage of a sacrococcygeal pilonidal abscess. JEmerg Med. 2009;36(1):60-63.
• 11.Demiral G, Limberg Flap in the Treatment ofPatients Presented with Sacrococcygeal AcutePilonidal Abscess: Long Term Results. Turk JColorectal Dis. 2017;27:126-9.
• 12.Khan MN, Vidya R, Lee RE. The limited role ofmicrobiological culture and sensitivity in themanagement of superficial soft tissue abscesses.ScientificWorldJournal. 2006;6;6:1118-23.
• 13.Nagy E, Boyanova L, Justesen US; ESCMID StudyGroup of Anaerobic Infections. How to isolate,identify and determine antimicrobial susceptibilityof anaerobic bacteria in routine laboratories. ClinMicrobiol Infect. 2018; 24(11):1139-48.
• 14.Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG,Fritsche TR. Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998-2004). Diagn Microbiol Infect Dis. 2007;57(1):7-13.
• 15.Özata İH, Arslan Ç, Karahan SN, et al. GeneralSurgeons’ Approach to Pilonidal Abscess in Turkey:Results of a Nationwide Survey. Turk J ColorectalDis. 2024;34(2):54-61.
• 16.Dryden MS. Skin and soft tissue infection:microbiology and epidemiology. Int J AntimicrobAgents. 2009;34 Suppl 1:S2-S7.
• 17.Ministry of Health, Public Health Institution ofTurkey, Department of Microbiology ReferenceLaboratories “National Antimicrobial ResistanceSurveillance System 2013 Annual Report.
• 18.Stevens DL, Bisno AL, Chambers HF, et al.Practice guidelines for the diagnosis andmanagement of skin and soft tissue infections: 2014update by the Infectious Diseases Society of America[published correction appears in Clin Infect Dis.2015 May 1;60(9):1448. Dosage error in articletext]. Clin Infect Dis. 2014;59(2):e10-e52.
• 19.Magiorakos AP, Srinivasan A, Carey RB, et al.Multidrug-resistant, extensively drug-resistant andpandrug-resistant bacteria: an international expertproposal for interim standard definitions foracquired resistance. Clin Microbiol Infect.2012;18(3):268-81.
• 20.İşgör A, Pilonidal hastalık. ANKEM Dergisi. 2011;25(2): 117-20.