Cutaneous Abscess – Management
- 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 currently.
- Frequently, cutaneous abscesses are obvious on clinical exam, but sometimes deep abscesses are not visible.
- It has been demonstrated that 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 it is recommended to 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).
- In general, the treatment of abscesses is incision and drainage; antibiotics are unnecessary in absence of surrounding cellulitis.
- However, in areas where the prevalence 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 incision should be up to half of the width of the abscess area, (see video: Abscess Incision and Drainage).
- Culture and sensitivity of abscess drainage material is not essential, but useful to establish local prevalence patterns of bacterial pathogens.
Criteria For Hospital Admission
- Hospitalization for cutaneous abscesses is usually not required.
Criteria For Transfer To Another Facility
- Not required.
Criteria For Close Observation And/or Consult
- Cutaneous abscesses in anatomically sensitive areas (face, perianal, perineal areas) may require referral.
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?
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Most patients with cutaneous abscesses may be safely discharged home unless there are mitigating circumstances (social, etc).
Barbic D, Chenkin J, Cho DD, Jelic T, Scheuermeyer FX. In patients presenting to the emergency department with skin and soft tissue infections what is the diagnostic accuracy of point-of-care ultrasonography for the diagnosis of abscess compared to the current standard of care? A systematic review and meta-analysis. BMJ Open. 2017 Jan 10;7(1):e013688. doi: 10.1136/bmjopen-2016-013688.
Wilmer A, Lloyd-Smith E, Romney MG, Champagne S, Wong T, Zhang W, Stenstrom R, Hull MW. Reduction in community-onset methicillin-resistant Staphylococcus aureus rates in an urban Canadian hospital setting. Epidemiol Infect. 2014 Mar;142(3):463-7. doi: 10.1017/S0950268813001568. Epub 2013 Jun 28.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Nov 20, 2017
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