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    Cutaneous Abscess – Management

    Infections

    Last Reviewed on Nov 20, 2017
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    First 5 Minutes

    Verify that there is not a more severe soft tissue infection such as necrotising fasciitis or sepsis complicating the abscess

    Context

    • Cutaneous abscesses are common in the emergency department and incidence has increased, likely due to the emergence of community-associated methicillin resistant staphylococcus aureus (CA-MRSA) as a major pathogen.
    • Depending on geographic location, up to 50% of cutaneous abscesses are caused by MRSA.
    • Frequently, cutaneous abscesses are obvious on exam, but sometimes deep abscesses are not visible.
    • Point of care ultrasound (POCUS) can aid in the diagnosis of deep abscesses.   This is important since the treatment of an abscess is incision and drainage (I and D). Therefore use POCUS in cases of cellulitis, particularly if the patient has risk factors for MRSA (prior MRSA infection, injection drug use, MSM, diabetes mellitus, hospital admission in prior 3 months).

    Please see the ultrasound image of an abscess File:UOTW 66 – Ultrasound of the Week 1.webm – WikiProjectMed (mdwiki.org)

    Attribution: Ben Smith, CC-BY-SA-4.0

    Recommended Treatment

    • In general, the treatment of abscesses is incision and drainage; antibiotics are not routinely needed  in absence of surrounding cellulitis.
      • However, in areas where the rates of CA-MRSA is high (>30%), treatment with a 7 day course of TMP-SMX is associated with higher cure rates.
      • Doxycycline is a reasonable alternative (5-7 days at 100 mg PO BID).  Sensitivity of CA-MRSA to TMP-SMX or doxycycline remains > 90%.
    • Proper abscess drainage is important and the incision should be up to half of the width of the abscess (see video: Abscess Incision and Drainage : Emergency Care BC)
    • Packing, while historically carried out, results in greater pain and has not been shown to improve outcomes.
    • Culture and sensitivity of abscess drainage material is not essential, but useful to establish local  patterns of bacterial pathogens.

    Criteria For Hospital Admission

    • Hospitalization for cutaneous abscesses is usually not required.

    Criteria For Transfer To Another Facility

    • Not generally required.

    Criteria For Close Observation And/or Consult

    • Cutaneous abscesses in anatomically sensitive areas (face, perianal, perineal areas) may require referral. In some cases they may be associated with an underlying fistula.

    Criteria For Safe Discharge Home

    • Most patients with cutaneous abscesses may be safely discharged home unless there are mitigating circumstances (social, etc).

    Quality Of Evidence?

    Justification

    Most patients with cutaneous abscesses may be safely discharged home unless there are mitigating circumstances (social, etc).

    High

    Related Information

    OTHER RELEVANT INFORMATION

    Reference List

    Relevant Resources

    RELEVANT CLINICAL RESOURCES

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    RELEVANT VIDEO

    00:00

    Abscess Incision and Drainage

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    RELEVANT RESEARCH IN BC

    Sepsis and Soft Tissue Infections

    RESOURCE AUTHOR(S)

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