Analysis of the distribution characteristics of infecting microorganisms in the wound tissue of patients with perianal abscess combined with infection and the influencing factors of wound healing (2025)

Objective

This study aimed to analyze the distribution characteristics of infecting microorganisms in the wound tissue of patients with perianal abscess and infection, as well as to identify factors affecting wound healing.

Methods

Two hundred patients with perianal abscess combined with infection admitted to our hospital from January 2023 to May 2024 were selected, all of whom underwent one-time radical surgery, and were divided into 155 cases with good quality of healing and 45 cases with poor quality of healing according to the healing status of wounds in the 2 weeks after surgery, and the traumatized tissue specimenss were collected for the cultivation and identification of infecting microorganisms to analyze the characteristics of the distribution of infecting microorganisms. The clinical data of the patients were collected, and the factors affecting wound healing were investigated using unifactorial and multifactorial analysis.

Results

In this study, 316 strains of infecting microorganisms were detected in two hundred patients, including 213 Gram-negative bacteria, 80 Gram-positive, and 23 fungal strains, of which the Gram-negative bacteria were dominated by Escherichia coli (E. coli)and Klebsiella pneumoniae(K. pneumoniae), and the Gram-positive bacteria were dominated by Staphylococcus aureus. The results of univariate analysis showed that body mass index, diabetes mellitus, concomitant infections, and stool traits were influential factors affecting the poor quality of wound healing (P < 0.05). The results of multifactorial logistic regression analysis showed that body mass index, diabetes mellitus, concurrent infections and stool traits were independent risk factors influencing the poor quality of wound healing (P < 0.05, P<0.05 indicates that the factor is statistically significant).

Conclusion

This study suggests that BMI, diabetes, concurrent infection and stool characteristics are independent risk factors for poor wound healing in patients with perianal abscess and infection. In clinical practice, it is recommended to implement personalized interventions targeting the above factors (such as optimizing nutritional support, strict blood glucose control, strengthening infection management, etc.) to improve patient prognosis. In the future, the universality of this conclusion needs to be further verified through multi center and large sample studies.

General information

The study is a retrospective study, Two hundred patients with perianal abscess combined with infection admitted to our hospital from January 2023 to May 2024 were selected, and the inclusion criteria were: ① Meeting the diagnostic criteria of perianal abscess [4] and confirmed by clinical manifestations and imaging examination; ② According to the diagnostic criteria of infection: local symptoms: redness, swelling, heat pain, obvious wave motion and obvious pain when pressing the perianal skin; Physical examination: there is a induration or mass around the anus. Wave motion can be palpable when palpating, and pus cavity may be found by digital rectal examination; Laboratory examination: blood routine showed that white blood cell count and neutrophil count increased, and inflammatory indicators such as C-reactive protein and procalcitonin also increased; ③ Age of 18 years old and above; ④ Meeting the indications for surgery and completing one-time radical surgery; ⑤ The appearance of traumatic corruption of tissue or secretion; ⑥ Presence of tissue necrosis or purulent secretion in the traumatic area; ⑦ The number of incisions is 3 or more; ⑧ The clinical data is complete, including but not limited to gender, age, body mass index, underlying disease history, surgical approach, incision selection, surgical time, postoperative recovery, etc. Exclusion criteria: ① Combining other serious diseases, such as malignant tumors, severe cardiopulmonary dysfunction, etc., may affect research results or patients’ quality of life; ② Mental illness unable to communicate; ③ Recent anal or colorectal surgery patients; ④ Keloid and coagulation disorders; ⑤ Patients with recurrent perianal diseases; ⑥ Pregnant or lactating women; ⑦ Poor compliance with treatment. This study was approved by the Ethics Committee of Shenyang Anorectal Hospital (approval No. KYR-2023038) and followed the ethical principles set forth in the Helsinki Declaration. All patients participating in this study were informed of the study objectives, methods, and potential risks, and signed informed consent forms. Exit study conditions (if applicable): The patient was unable to continue participating in the study due to personal reasons such as relocation or loss of contact during the study period. The patient experienced serious adverse events during the study and was deemed necessary to withdraw from the study by the researchers.

The patient violated the research protocol during the study period, such as failing to undergo surgery or postoperative treatment as required.

Declaration of Consent for Participation: All patients included in this study were fully informed of the nature, purpose, methods, potential risks, and potential benefits of the study, and voluntarily signed a written informed consent form without any coercion or undue influence. We promise to protect the privacy and personal information of patients and ensure that it will not be disclosed to unauthorized third parties.

Release a statement of agreement: The release of data, results, and conclusions in this study was with the consent of the participants (as explicitly stated in the informed consent form). We respect the privacy rights of participants and promise to comply with relevant privacy protection regulations and ethical principles when publishing any research related data.

Surgical methods

Preoperative preparation

Position and anesthesia: the patient takes the truncated position supine, undergoes routine disinfection, and chooses local anesthesia or lumbar/sacral anesthesia according to the size of the abscess. Examination and localization: preoperative examinations such as magnetic resonance are used to clarify the location of the abscess and the location of the internal opening to improve the success rate of the surgery.

Surgical operation

Incision and drainage: the abscess is incised with the anus as the center. For unilateral small abscess, the incision is suitable to be radial, and the incision slightly exceeds the scope of abscess; for large abscess, the incision is suitable to be curved, and the incision terminates at the edge of abscess. After incision, the pus is released to relieve pressure in the cystic cavity and reduce pain [8].

Probing the internal opening: A probe or ball-ended silver probe is used to probe the internal opening of the abscess, the source of infection. This step is critical to the success of the procedure and requires the experience and skill of the surgeon.

Management of the internal opening and abscess cavity: incise the internal opening and abscess cavity along the probe and remove sclerotic tissue from the internal opening. In patients with abscesses located in the pelvicorectal space, hanging may be necessary. At the same time, remove necrotic tissue from the abscess cavity to ensure drainage is patent.

Flushing and filling: The abscess cavity is flushed using a solution such as saline or hydrogen peroxide to ensure that no pus remains. Then, use gauze to fill the pus cavity and do drainage treatment.

Hemostasis and bandaging: After checking the wound and pus cavity for no active bleeding, perform hemostasis treatment. Finally, use dressing to bandage the wound.

Postoperative treatment

Wound cleansing and dressing change: Wound cleansing and gauze drainage are performed every day after surgery until the skin is closed. At the same time, regular dressing changes are needed to prevent pseudo-healing.

Sitz bath and medication: Use potassium permanganate solution for a sitz bath after bowel movements to keep the perianal area clean and hygienic. Follow the doctor’s instructions for antimicrobial treatment to control the infection and promote healing.

Diet and life adjustment: keep a light diet, avoid spicy, greasy, cold and other stimulating food. Eat more foods rich in vitamins and dietary fiber, such as apples, bananas, carrots, etc., as well as foods rich in protein, such as eggs and beef. At the same time, maintain good bowel habits and avoid prolonged bowel movements and excessive straining.

Review and Follow-up: Regularly visit the General Surgery Department of the hospital for review and tightening of hanging wires to understand the wound healing. If there are any uncomfortable symptoms, you should seek medical treatment in time.

Pollution prevention measures: Ensure that all sampling tools (such as disposable sterile syringes, scrapers, etc.) are sterile packaged and not contaminated before use. During the sampling process, the operator should wear sterile gloves to avoid direct contact with the patient’s skin or surgical area. When using a syringe to extract pus, ensure that the needle is fully inserted into the abscess cavity to avoid pus overflow or contamination of the surrounding skin. The collected specimenss should be immediately sent to the laboratory for bacterial culture, avoiding prolonged storage at room temperature to reduce the risk of bacterial proliferation and contamination. During transportation, sterile containers should be used to store specimenss and ensure the sealing of the containers. After arriving at the laboratory, the specimenss should be processed immediately to avoid prolonged exposure to the laboratory environment. When handling specimenss, the laboratory’s sterile operating procedures should be strictly followed.

All patients’ surgeries are performed by the same surgeon.

Postoperative wound healing assessment

According to the wound healing situation 2 weeks after the operation, it was divided into 155 cases in the group with good quality of healing and 45 cases in the group with poor quality of healing, and the quality of wound healing was assessed as follows [9]:

Good wound healing: (1) disappearance of clinical symptoms: the main symptoms of patients, such as pain, swelling, etc., completely disappeared. (2) Good growth of granulation tissue: the granulation tissue was bright red granular, with vigorous growth and no obvious secretion. (3) Complete epithelialization of the wound: the wound is covered with neoplastic epithelium and no dressing change is needed. 4High healing rate: the healing rate of the wound reaches or exceeds 90%.

Poor wound healing: Poor wound healing: 1. Persistent pain: The patient’s postoperative pain level is high, affecting sleep and daily life, requiring the use of painkillers.2. Slow or no growth of granulation tissue: The color of granulation tissue is dull, the growth is slow or no growth, and the flatness of the wound is poor. 3. Excessive secretion: There is a lot of exudate from the wound, soaking more than one-third of the dressing. 4. Extended healing time: The wound healing time is significantly prolonged, exceeding the expected time. 5. Low healing rate: The wound healing rate is less than 40%.

Data collection: gender, age, career, body mass index, chronic constipation, thyroid disease, diabetes mellitus, tumor, chronic gastroenteritis, choice of procedure, choice of incision, duration of surgery, complication of local hematoma, complication of infection, time to return to normal activity, average daily sitz bath time, stool character.

Diagnostic criteria:

Chronic constipation [10]: According to the Rome IV criteria, the diagnosis of constipation requires that the following symptoms have been present for at least 6 months, and the symptoms in the past 3 months meet at least two of the following criteria: difficulty in defecation (≥ 25% of bowel movements); Defecation is in the form of lumps or hard stools (≥ 25% of bowel movements); Having incomplete bowel movements (≥ 25% of bowel movements); Feeling of anorectal obstruction or blockage during defecation (≥ 25% of bowel movements); Defecation requires manual assistance (such as finger assisted defecation, pelvic floor support defecation); Less than 3 bowel movements per week.

Thyroid diseases [11]: including hyperthyroidism and hypothyroidism, diagnosed based on thyroid function tests (TSH, T3, T4 levels) and clinical manifestations.

Hyperthyroidism: TSH decreases, T3 and T4 increase, accompanied by symptoms such as excessive sweating, palpitations, and weight loss.

Hypothyroidism: Elevated TSH, decreased T3 and T4, accompanied by symptoms such as fatigue, chills, and weight gain.

Diabetes [12]: according to the World Health Organization (WHO) standard, fasting blood glucose ≥ 7.0 mmol/L or blood glucose ≥ 11.1 mmol/L in the 2-hour oral glucose tolerance test (OGTT), or random blood glucose ≥ 11.1 mmol/L, accompanied by diabetes symptoms (such as polydipsia, polydipsia, polyuria, weight loss).

Tumor [13]: Diagnosed as a malignant tumor through imaging examinations (such as B-ultrasound, CT, MRI), histopathological examination, etc.

Chronic gastroenteritis [14]: characterized by long-term (at least 3 months) symptoms such as abdominal pain, bloating, diarrhea, or constipation, which may be accompanied by nausea, vomiting, acid reflux, etc. It is diagnosed through gastroscopy and pathological examination.

Concurrent local hematoma [15]: swelling and pain occur locally after surgery or trauma, with a wave like sensation on palpation. B-ultrasound examination can confirm the diagnosis.

Infecting microorganisms detection

Under the condition of aseptic operation, use a disposable sterile syringe to extract the pus in the cavity of perianal abscess or the secretion of anal fistula. Usually 3 mL of specimens is collected, and if the secretion is difficult to collect, a small amount of tissue can be scraped using a spatula. For patients who have become visibly pus-filled, a 2- to 5-mL specimens of pus is withdrawn directly with a 20-mL syringe after local disinfection at the time of dressing change. The collected specimens should be immediately sent to the laboratory for bacterial culture. During transportation, it is necessary to ensure the sterility of the specimens to avoid contamination. After the specimens arrives at the laboratory, follow the instructions《National Clinical Laboratory Operating Procedures》Cultivate infecting microorganisms and use a fully automated microbial identification system such as VITEK 2 Compact for colony identification.

Statistical methods

SPSS 24.0 statistical software was used for data analysis. For metric data, normality test is first performed. For metric data that conforms to normal distribution, mean ± standard deviation (x̅ ± s) is used to represent it. Independent sample t-test is used for inter group comparison; For metric data that do not follow a normal distribution, median and interquartile range are used to represent them, and Mann Whitney U test is used for inter group comparison. Count data is presented in terms of number of cases and percentage [cases (%)], and inter group comparisons are conducted using the chi square test or Fisher’s exact probability method (when the sample size is small). In univariate analysis, we used chi square test or Fisher’s exact probability method for comparison, and Mann Whitney U test for inter group comparison. In multi factor logistic regression analysis, the Forward Stepwise Regression method is used to screen independent variables and construct the optimal model. During the model construction process, we observed the regression coefficient (β), standard error (SE), Wald value, P-value, odds ratio (OR), and 95% confidence interval (95% CI) of each variable. Finally, P < 0.05 is considered statistically significant.

Distribution characteristics of microorganisms in wound tissue

This study cultured and identified infecting microorganisms in wound tissues of two hundred patients with perianal abscess complicated with infection, and a total of 316 strains of infecting microorganisms were detected. Among them, there are 213 Gram-negative bacteria, accounting for 67.40% of the total bacterial population; 80 strains of Gram-positive bacteria, accounting for 25.32% of the total bacterial population; There are 23 fungi, accounting for 7.28% of the total number of fungi. The specific distribution is as follows:

Gram-negative bacteria: mainly E. coli (142 strains, accounting for 66.67% of Gram-negative bacteria) and K. pneumoniae (29 strains, accounting for 13.62% of Gram-negative bacteria), as well as Proteus mirabilis (15 strains), Acinetobacter baumannii (7 strains), Pseudomonas aeruginosa (6 strains), Molluscum brueckii (5 strains), Proteus mirabilis (3 strains), Enterobacter aerogenes (3 strains), and other unclassified Gram-negative bacteria (3 strains).

Gram-positive bacteria: Staphylococcus aureus (50 strains, accounting for 62.50% of Gram-positive bacteria) is the main strain, including Enterococcus faecalis (10 strains), Enterococcus faecalis (7 strains), Staphylococcus epidermidis (6 strains), Streptococcus pyogenes (4 strains), and other unclassified Gram-positive bacteria (3 strains).

Fungi: including Candida albicans (9 strains), Candida albicans (7 strains), and other unclassified fungi (7 strains).

According to age and gender distribution, there was no statistically significant difference in the proportion of gram-negative bacteria, gram-positive bacteria, and fungi between different ages and genders (P > 0.05).See Fig.1.

Univariate analysis of influencing factors of poor quality of wound healing

Next, we examined the influencing factors related to poor wound healing quality using univariate analysis. The results of univariate analysis showed that body mass index, diabetes, concurrent infection and stool traits were the influencing factors for the poor quality of wound healing (P < 0.05). See Table1.

Factors influencing poor wound healing quality were analyzed with multi-factor logistics regression analysis

The indicators with statistical significance in Table2 were taken as independent variables, and the wound healing of patients with perianal abscess complicated with infection was taken as dependent variable. The values of independent variables are shown in Table2. Multivariate Logistics regression analysis showed that body mass index, diabetes, complicated infection and stool traits were the independent risk factors for poor wound healing quality (P < 0.05). See Table3; Fig.2.

Horizontal axis: represents the logarithmic value (log (OR)) of the regression coefficient (β) of each influencing factor, reflecting the direction and degree of the impact of each factor on the poor quality of wound healing. Positive values indicate an increased risk of poor wound healing quality due to this factor, while negative values indicate the opposite.

Vertical line: represents the range of the 95% confidence interval (95% CI) for the regression coefficient. If the vertical line intersects with an invalid line (usually the vertical line x = 0 or log (OR) = 0), it indicates that the factor is not statistically significant.

Block: represents the estimated values of regression coefficients for each factor and their corresponding confidence intervals. The size of the block reflects the weight or sample size of the factor in the model.

Line: The line connecting the two ends of the block represents the range of the 95% confidence interval.

Factor name: four independent risk factors affecting poor wound healing quality are listed in the figure, namely body mass index, diabetes, concurrent infection and stool characteristics.

Perianal abscess is a common anorectal disease, mostly caused by anal gland infections, if not treated in time, it can lead to the spread of infection and cause serious complications such as systemic inflammatory response syndrome, and perianal abscess co-infected patients have difficulty in wound healing, which prolongs the hospitalization time of the patients, and increases the pain and economic burden of the patients [16]. Therefore, understanding the distribution characteristics of infecting microorganisms in the wound tissue of patients with perianal abscess co-infection and the factors affecting wound healing is of great significance in guiding clinical treatment. The results of this study showed that the traumatic tissue infecting microorganisms in patients with perianal abscess co-infection were predominantly Gram-negative bacteria, similar to the results of previous studies. Gram-negative bacteria such as E. coli, K. pneumoniae, and Proteus mirabilis are common pathogens in perianal abscess co-infection, which may be related to factors such as intestinal flora dysbiosis and poor local hygiene around the anus. As the normal flora of the intestinal tract, E. coli may proliferate and disseminate outward during intestinal dysbiosis, leading to infections in adjacent tissues, including perianal abscesses, Moreover to endotoxins and other pathogenic factors of E. coli that can trigger suppurative acute inflammation and abscess formation [17]. E. coli is an important opportunistic pathogen, especially in immunocompromised populations, which can cause lower respiratory tract infections, but also extra-intestinal infections, such as perianal abscesses, through other routes (e.g., blood transmission) [18]. The detection rate of Gram-positive bacteria and fungi in the wound tissue of patients with perianal abscess co-infections is relatively low, but their influence on wound healing should not be ignored. Further analysis revealed that E. coli and K Pneumoniae exhibits a coexistence trend in some patients, which may be related to their ecological niche similarity and common pathogenic mechanisms. In addition, although Gram-positive bacteria such as Staphylococcus aureus have a low detection rate, their impact on wound healing cannot be ignored. Future research can further explore the interactions between different microorganisms and their specific mechanisms of influence on wound healing. In this study, further analysis of age and gender factors found that there was no significant difference in the proportion of Gram-negative bacteria, Gram-positive bacteria and fungi between different ages and genders (p > 0.05). It may be related to the population included in this study. The average age of patients is (45.2 ± 12.3) years old. However, this does not mean that age and gender have no effect on the development of perianal abscess complicated with infection. For subsequent studies, we can still further explore its interaction with other potential factors.

Multivariate logistic regression analysis showed that body mass index, diabetes mellitus, concurrent infection and stool traits were independent risk factors affecting the quality of wound healing (P < 0.05). This means that these factors independently affect the quality of wound healing. For example, the risk of poor wound healing quality will change with each unit of body mass index (measured by the grouping criteria set by the study), and the odds ratio is 5.037 (95% CI:1.672–14.201). Compared with non-diabetic patients, diabetic patients had an increased risk of poor wound healing quality, with an odds ratio of 3.156 (95% CI: 1.521–6.529). Concurrent infection and specific fecal traits (such as type 1–2 and type 6–7 feces defined in the study) also significantly increased the risk of poor wound healing quality, with odds ratios of 4.723 (95% CI:1.440-14.264) and 6.429 (95%CI: 1.811–20.416), respectively. These results provide an important basis for clinicians to identify high-risk patients and take targeted intervention measures. Low body mass index usually means that the patient is underweight and may be malnourished, which can lead to low immunity, which makes the patient more susceptible to bacterial attack (e.g., Gram-negative bacteria such as E. coli, K. pneumoniae, and Aspergillus chimericus), which can lead to infectious diseases such as perianal abscesses [19]. Obese patients (with excessive BMI) often have excessive fat tissue. Adipose cells can secrete various inflammatory factors, such as tumor necrosis factor - α (TNF - α), interleukin-6 (IL-6), etc. In patients with perianal abscess infection, these inflammatory factors can further exacerbate local inflammatory reactions, interfere with normal cell proliferation and tissue repair during wound healing. Meanwhile, obesity leads to relatively poor local tissue blood circulation, affecting the supply of nutrients and oxygen, limiting the cellular metabolism and repair activities required for wound healing, thereby increasing the risk of poor wound healing quality [20]. A low body mass index may indicate that the patient is suffering from malnutrition. Lack of nutrients such as protein, vitamins, minerals, etc. can affect the synthesis of collagen, which is an important extracellular matrix component in the wound healing process. Insufficient synthesis of collagen can lead to slow and poor quality wound healing. Furthermore, patients with low body weight may have relatively weaker immune function, and their ability to resist infections and promote tissue repair may decrease, which is not conducive to the healing of perianal abscess wounds. The hyperglycemic environment of diabetic patients provides a favorable growth environment for pathogenic microorganisms, which reduces the phagocytic ability and bactericidal effect of leukocytes, making the body less resistant to infection, and therefore, it is often difficult to control the perianal abscess infection once it occurs [20]. Diabetic patients are prone to vasculopathy, resulting in impaired blood circulation. This affects the blood supply to the wound, making it impossible to deliver the nutrients and oxygen needed for wound healing in a timely manner, thus affecting the quality of healing [21]. Peripheral and autonomic neuropathy in diabetic patients may also affect wound healing. Peripheral neuropathy can lead to abnormal loss of sensation in the limbs, which is not easy to be detected at an early stage once the damage is done, and is prone to infections; autonomic neuropathy can lead to weakness of the bladder muscle, causing urinary retention, which increases the risk of infections [22]. Metabolic disorders in the body of diabetic patients can also affect wound healing. Studies have confirmed that a hyperglycemic state affects vascular epithelial cell production, which in turn leads to hypoxia in the granulation tissue and affects protein synthesis, which can lead to delayed wound healing [23]. These multiple mechanisms of diabetes interact with each other, comprehensively disrupting the normal wound - healing process in patients with perianal abscesses. The hyperglycemia - induced increase in bacterial growth and the impairment of blood circulation, nerve function, and metabolism all contribute to the poor healing of perianal abscess wounds, making it difficult for the body to repair the damaged tissue effectively. In the case of perianal abscesses, the perianal area is already a potential site for bacterial infection. The hyperglycemic environment in diabetic patients further promotes the growth of bacteria such as Escherichia coli and Klebsiella pneumoniae, which are common pathogens in perianal abscesses. This not only exacerbates the existing infection but also makes it more difficult for the body to clear the infection during the wound - healing process. Perianal abscess itself is a infectious diseases. If it is accompanied by infection in other parts, the toxin produced by bacteria will further destroy the tissue cells around the wound. For example, certain bacterial toxins can inhibit the activity of fibroblasts, which are key cells for synthesizing collagen. Inhibiting their activity can lead to a decrease in collagen synthesis, affecting wound healing and repair. Toxins may also cause damage to local vascular endothelial cells, leading to increased vascular permeability, tissue edema, obstruction of nutrient transport and intercellular substance exchange, which is not conducive to wound healing and reduces healing quality [24]. When there is concurrent infection, the body’s immune system needs to deal with multiple infection sites simultaneously, which will disperse immune resources. This weakens the local immune defense ability of perianal abscess wounds, making it difficult to effectively remove bacteria and necrotic tissue from the wound, prolong the inflammatory response time, delay the wound healing process, and increase the likelihood of poor wound healing [25]. Complicated infections can cause the body to be in a state of high metabolism, consuming a large amount of nutrients and energy, leaving patients in a state of malnutrition, which in turn affects wound repair and healing. Prolonged or repeated use of antibiotics may lead to bacterial resistance, making anti-infection treatment more difficult, leading to difficulty in controlling the infection and further affecting the quality of wound healing [26]. Constipated patients need to exert force during defecation, which may lead to additional pressure on the trauma after perianal abscess surgery, thus slowing down the healing process. Additionally, constipation may lead to dry stools, and dry hard stools may scratch the wound that has not fully healed, increasing the risk of infection. The water and bacteria in dilute stools may be more likely to contaminate the wound, increasing the risk of infection; frequent defecation and dilute stools may lead to a prolonged period of time in which the wound is wet, which is not conducive to the drying and crusting of the wound, thus affecting the quality of healing [27–28]. However, due to limitations in the laboratory conditions of this study, such as the complexity of anaerobic cultivation techniques and potential oxygen exposure during sample processing, we were unable to conduct in-depth research on specific anaerobic pathogens. Nevertheless, we recognize the potential importance of obligate anaerobic pathogens in perianal abscesses and recommend the use of more advanced anaerobic culture techniques in future research to comprehensively evaluate their distribution and impact. Further analysis reveals that there are significant interactions between these factors. For example, in diabetes patients, BMI has a more significant impact on wound healing, which may be related to metabolic disorder and decreased immunity in diabetes patients. Meanwhile, concurrent infections can further exacerbate the inflammatory response, damage wound tissue, and thus delay the wound healing process. In addition, the characteristics of feces are closely related to wound healing, and constipation or diarrhea may lead to wound contamination and infection, thereby affecting the quality of healing. Therefore, in clinical practice, it is necessary to comprehensively consider the interaction between various factors and develop personalized treatment plans. Take patient A as an example. This patient is a middle-aged male with diabetes and obesity. He was hospitalized for perianal abscess and infection. After surgery, the patient’s wound healed slowly, accompanied by persistent pain and increased secretions. The analysis found that the patients’ high BMI and diabetes status were the key factors leading to poor wound healing. This is consistent with our findings that BMI and diabetes are independent risk factors for wound healing. By adjusting the treatment plan, strengthening anti infective therapy, nutritional support, and wound care, the patient ultimately recovered smoothly. This case further validates our research conclusions and suggests that clinicians should pay more attention to factors such as BMI and diabetes status of patients when treating patients with perianal abscess and infection. The results of this study provide important reference for the clinical treatment of patients with perianal abscess complicated with infection. Based on the research results, we put forward the following clinical recommendations: for high-risk patients (such as high BMI, diabetes, concurrent infection, etc.), more active treatment measures should be taken, such as strengthening anti infection treatment, optimizing nutritional support, adjusting the operation mode, etc. Meanwhile, strengthening wound care and patient education are also important measures to promote wound healing. Through comprehensive treatment and individualized care, the treatment effectiveness and quality of life of patients can be significantly improved.

The gut microbiota, as the largest microecological system in the human body, plays an important role in maintaining intestinal health and regulating immune function. Recent studies have shown that intestinal flora imbalance is closely related to the occurrence and development of a variety of infectious diseases, including perianal abscess and other extraintestinal infectious diseases [29–30]. Dysbiosis of gut microbiota may lead to the overgrowth of certain harmful bacteria, which spread to perianal tissues through blood, lymphatic, and other pathways, causing infection and forming abscesses. Another point to consider, gut microbiota also plays an important role in the wound healing process. A healthy gut microbiota can promote the absorption and utilization of nutrients, providing necessary energy and materials for wound healing. Meanwhile, gut microbiota can also regulate the local immune environment, inhibit the growth of harmful bacteria, reduce the risk of infection, and promote wound healing [31]. Therefore, when exploring the distribution characteristics of infecting microorganisms in wound tissues of patients with perianal abscess complicated with infection and the influencing factors of wound healing, the role of gut microbiota cannot be ignored. For patients with perianal abscess, dysbiosis of gut microbiota may lead to excessive growth of harmful bacteria and spread to perianal tissues through blood, lymphatic and other pathways, causing infection. In addition, changes in the immune microenvironment may also affect the wound healing process. Future research can further explore the mechanisms of gut microbiota and immune microenvironment in perianal abscess and wound healing, as well as how to promote wound healing by regulating gut microbiota and immune microenvironment. This will provide new ideas and methods for clinical treatment, and provide scientific basis for the development of new treatment methods.

Intervention measures: keep the wound clean and dry, change the dressing regularly, and avoid contamination of the wound by feces and other pollutants; ensure that patients consume enough nutrients, especially protein, vitamins and minerals, which can be achieved by adjusting the dietary structure and increasing the nutritional supplements; and control the blood glucose in the normal range by oral hypoglycemic drugs or injecting insulin. Enhancing the patient’s immunity through appropriate exercise, rest and maintaining a good state of mind will help fight infection and promote wound healing. Once perianal abscess or constipation/diarrhea occurs, consult a doctor and take medication as prescribed by the doctor to avoid self-abuse of medication or delay in treatment. Active control of infection is the key to wound healing, and appropriate antibiotics should be selected according to the type of infecting microorganisms and the results of drug sensitivity test for treatment.

This study suggests that BMI, diabetes, concurrent infection and stool characteristics are independent risk factors for poor wound healing in patients with perianal abscess and infection. In clinical practice, it is recommended to implement personalized interventions targeting the above factors (such as optimizing nutritional support, strict blood glucose control, strengthening infection management, etc.) to improve patient prognosis. In the future, the universality of this conclusion needs to be further verified through multi center and large sample studies.

Practical clinical significance: The results of this study provide scientific basis for the clinical treatment of perianal abscess complicated with infection, and help guide doctors to develop more reasonable treatment strategies and nursing plans. By intervening in the above-mentioned risk factors, the treatment effect of patients can be significantly improved, the healing time can be shortened, the pain of patients can be alleviated, the incidence of complications can be reduced, and the quality of life of patients can be improved.

Future research direction: Future studies can further explore the specific mechanisms by which different pathogens affect wound healing, as well as effective treatment methods for different pathogens. In addition, other factors that may affect wound healing, such as the patient’s psychological and socio-economic status, can also be studied, and more comprehensive and personalized treatment strategies can be explored. Meanwhile, with the development of molecular biology and biotechnology, future research based on genomics and proteomics can be conducted to gain a deeper understanding of the pathogenesis and therapeutic targets of perianal abscess associated infections.

This study has the following limitations: ① A single center retrospective design may lead to selection bias; ② Not included in the metagenomic analysis of gut microbiota, making it difficult to comprehensively evaluate the microbial host interaction mechanism; ③ The follow-up time is relatively short (only 2 weeks), making it impossible to evaluate the quality of long-term healing; ④ The lack of specialized cultivation of anaerobic bacteria may underestimate the proportion of anaerobic bacterial infections. In the future, prospective cohort studies and multi omics techniques are needed to further explore the association between microbial diversity and healing outcomes.

BMI:

Body mass index

CI:

Confidence interval

DM:

Diabetes mellitus

OR:

Odds ratio

SE:

Standard error

Authors and Affiliations

1. The First Ward of Gastrocolorectal Surgery, Shenyang Anorectal Hospital, No. 9 Nanjing North Street, Heping District, Shenyang, 121000, China

   Luji Qiao,Hongjian Gao,Yi You&Jinliang Zhu

Contributions

Conception and design: LQ. Method: HG. Data Collection: YY and JZ. Manuscript Writing: LQ and HG. Manuscript revision: LQ and JZ. Research supervision: LQ and HG. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Luji Qiao.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Shenyang Anorectal Hospital (approval No. KYR-2023038) and followed the ethical principles set forth in the Helsinki Declaration. All patients participating in this study were informed of the study objectives, methods, and potential risks, and signed informed consent forms. All patients included in this study were fully informed of the nature, purpose, methods, potential risks, and potential benefits of the study, and voluntarily signed a written informed consent form without any coercion or undue influence. We promise to protect the privacy and personal information of patients and ensure that it will not be disclosed to unauthorized third parties.

Consent for publication

The release of data, results, and conclusions in this study was with the consent of the participants (as explicitly stated in the informed consent form). We respect the privacy rights of participants and promise to comply with relevant privacy protection regulations and ethical principles when publishing any research related data.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions