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  • Title: Group Milleri Streptococci in perianal infections.
    Author: Stelzmueller I, Aigner F, Albright J, Margreiter R, Fille M, Swenson BR, Dossett L, Bonatti H.
    Journal: Colorectal Dis; 2010 Jul; 12(7 Online):e121-7. PubMed ID: 19341401.
    Abstract:
    BACKGROUND: Anal abscesses are commonly associated with fistulas-in-ano and are usually polymicrobial in nature, with gram-negative rods and anaerobes being the most prevalent isolates. Group Milleri Streptococci (GMS) comprise a heterogeneous group of cocci, which are capable of causing severe purulent infection with a high recurrence rate. METHOD: All anorectal infections caused by GMS, which were identified at our centre during a 4-year period were retrospectively analysed. The 18 patients with GMS-positive anorectal abscesses were matched with 36 GMS-negative anorectal abscesses to identify outcome characteristics of this clinical entity. RESULTS: During the study period, 358 patients underwent surgical treatment for anal infections; GMS were isolated in 46 individuals (13%) including 18 perianal abscesses, 11 pilonidal sinuses, eight fistulae in and nine miscellaneous infections. Seventy-two per cent of perianal GMS infections were polymicrobial with E. coli and Bacteroides fragilis being the predominant second bacteria. Nine patients (20%) developed recurrent abscesses and fistulae-in-ano and underwent additional surgical interventions with resolution at follow-up. Additional antibiotic treatment was administered in 10 patients with complex anal infections. Matched pair analysis revealed that GMS-positive perianal abscesses were more commonly polymicrobial, and that the recurrence rate was higher (55.6% GMS-positive and 22.2% GMS-negative patients, P = 0.017). CONCLUSIONS: Our data confirm the propensity of GMS to form deep and recurrent abscesses with a higher recurrence rate than non-GMS infections. First-line treatment includes surgical drainage, and antibiotic treatment may be useful in selected patients.
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