Impact of ozonated water on perianal infectious diseases: A retrospective study

Abstract

BACKGROUND

Perianal abscess is an abscess caused by acute or chronic infection in the space surrounding the rectum and anal canal. If untreated or improperly managed, it may progress to a chronic infection and develop into an anal fistula, severely threatening patient health.

AIM

To investigate the therapeutic benefits of perianal infectious diseases by evaluating its bactericidal effects on pathogenic bacteria, its influence on tissue growth factor expression, and its macroscopic effects on tissue repair.

METHODS

Medical records of 65 patients with perianal abscess or anal fistula admitted to the Guihang Guiyang Hospital between January 2022 and May 2022 were retrospectively reviewed. The distribution of bacterial strains isolated from pus and secretion cultures collected pre-operatively and intra-operatively was analyzed, and the five most common pathogenic bacteria were identified. Ozonated water at varying concentrations was then applied to the cultured bacteria to evaluate bactericidal effects within the same exposure time and determine the minimum effective concentration (Cmin) capable of eliminating the major pathogenic bacteria associated with common perianal infectious diseases. Additionally, another patient cohort of 143 patients with perineal abscess or anal fistula treated between June 2022 and April 2024 was enrolled, including 79 patients in the observation group receiving ozone treatment and 64 patients in the control group receiving routine therapy. Both groups underwent surgical intervention. The control group additionally received routine anti-inflammatory therapy, sitz baths, and postoperative wound dressing changes. In addition to these treatments, the observation group received postoperative irrigation of the abscess cavity wound with ozonated water at concentration Cmin (100 mL, rinsed for 1 minute, once in the morning and once in the evening). After intervention, the expression levels of vascular endothelial growth factor, transforming growth factor-β, and platelet-derived growth factor in perianal wound tissue were assessed, and the wound healing outcomes were compared between groups.

RESULTS

Among the 65 patients, 56 showed positive bacterial cultures from pyogenic fluids. The identified bacteria were categorized as follows: (1) Pathogenic bacteria: Escherichia coli (34/56), Klebsiella pneumoniae (11/56), Staphylococcus aureus (4/56), Enterococcus faecium (3/56), and Proteus mirabilis (2/56); and (2) Nonpathogenic bacteria: Miscellaneous bacteria, including normal skin flora (2/56). Under the same exposure time, ozonated water exerted stronger bactericidal effects with increasing concentration and achieved complete elimination of the above pathogenic bacteria within 1 minute at a Cmin of 2.5 mg/L. The observation group showed significantly higher expression levels of tissue growth factors than the controls after treatment (vascular endothelial growth factor: 36.42 ± 1.60 vs 25.85 ± 1.18; transforming growth factor-β: 15.81 ± 2.04 vs 10.63 ± 0.80; platelet-derived growth factor: 33.32 ± 1.48 vs 24.75 ± 1.75; P < 0.001). At one week after treatment, the observation group also demonstrated significantly reduced wound secretion (0.92 ± 0.47 vs 1.27 ± 0.54; P < 0.001), tissue edema (0.54 ± 0.50 vs 0.94 ± 0.77; P < 0.05), and postoperative pain (1.77 ± 0.80 vs 2.94 ± 1.10; P < 0.001), along with significantly faster granulation tissue growth (0.67 ± 0.65 vs 1.19 ± 0.69; P < 0.001) compared with the control group.

CONCLUSION

Ozonated water irrigation is an effective approach for managing infected wounds in patients with perianal abscess or anal fistula and demonstrates promising clinical application value.

Keywords: Perianal abscess; Ozonated water; Growth factor; Wound healing; Retrospective study

Core Tip: If a perianal abscess is not treated promptly or is improperly managed, it may progress into a chronic infection and form an anal fistula, seriously threatening patient health. Surgical intervention remains the primary treatment approach. Although surgery provides reliable short-term efficacy, it is highly invasive and involves prolonged wound healing. Ozone, owing to its strong oxidizing properties, has been increasingly used in clinical practice and has demonstrated beneficial effects in promoting wound healing. However, few studies have investigated the use of ozonated water for treating infected wounds in the perianal region, which presents unique management challenges. Therefore, this study primarily evaluated the therapeutic efficacy of ozonated water for infected perianal wounds.