Abscess: Difference between revisions

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imported>Robert Badgett
(→‎Antibiotics: Added two references)
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A [[clinical practice guideline]] by the Infectious Disease Society of American concludes that "gram stain, culture, and systemic antibiotics are rarely necessary"<ref name="pmid16231249">{{cite journal |author=Stevens DL, Bisno AL, Chambers HF, ''et al'' |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections |journal=Clin. Infect. Dis. |volume=41 |issue=10 |pages=1373–406 |year=2005 |month=November |pmid=16231249 |doi=10.1086/497143 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID37519 |issn=}}</ref>; however, according the [http://guidelines.gov National Guideline Clearinghouse] summary of this guideline, the guideline was not a [[systematic review]] of the evidence.<ref name="urlPractice guidelines for the diagnosis and management of skin and soft-tissue infections.">{{cite web |url=http://guidelines.gov/summary/summary.aspx?ss=15&doc_id=8206&string=#s22 |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections. |author=Anonymous |authorlink= |coauthors= |date=2005 |format= |work= |publisher=National Guidelines Clearinghouse |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
A [[clinical practice guideline]] by the Infectious Disease Society of American concludes that "gram stain, culture, and systemic antibiotics are rarely necessary"<ref name="pmid16231249">{{cite journal |author=Stevens DL, Bisno AL, Chambers HF, ''et al'' |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections |journal=Clin. Infect. Dis. |volume=41 |issue=10 |pages=1373–406 |year=2005 |month=November |pmid=16231249 |doi=10.1086/497143 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID37519 |issn=}}</ref>; however, according the [http://guidelines.gov National Guideline Clearinghouse] summary of this guideline, the guideline was not a [[systematic review]] of the evidence.<ref name="urlPractice guidelines for the diagnosis and management of skin and soft-tissue infections.">{{cite web |url=http://guidelines.gov/summary/summary.aspx?ss=15&doc_id=8206&string=#s22 |title=Practice guidelines for the diagnosis and management of skin and soft-tissue infections. |author=Anonymous |authorlink= |coauthors= |date=2005 |format= |work= |publisher=National Guidelines Clearinghouse |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>


A more recent [[randomized controlled trial]] confirms these results<ref name="pmid17846141">{{cite journal |author=Rajendran PM, Young D, Maurer T, ''et al'' |title=Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection |journal=Antimicrob. Agents Chemother. |volume=51 |issue=11 |pages=4044–8 |year=2007 |pmid=17846141 |doi=10.1128/AAC.00377-07}}</ref>; although in this trial  87.8% were methicillin-resistant [[staphylococcus aureus]] (MRSA) yet the antibiotic used was [[cephalexin]]. It is not known if an antibiotic effective against MRSA would have reducted the rate of treatment failures below the 10% failure rate observed in the trial.
A more recent [[randomized controlled trial]] confirms these results<ref name="pmid17846141">{{cite journal |author=Rajendran PM, Young D, Maurer T, ''et al'' |title=Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection |journal=Antimicrob. Agents Chemother. |volume=51 |issue=11 |pages=4044–8 |year=2007 |pmid=17846141 |doi=10.1128/AAC.00377-07}}</ref>; although in this trial  87.8% were methicillin-resistant [[staphylococcus aureus]] (MRSA) yet the antibiotic used was [[cephalexin]]. It is not known if an antibiotic effective against MRSA would have reducted the rate of treatment failures below the 10% failure rate observed in the trial. Older trials also are available.<ref name="pmid322789">{{cite journal |author=Macfie J, Harvey J |title=The treatment of acute superficial abscesses: a prospective clinical trial |journal=The British journal of surgery |volume=64 |issue=4 |pages=264–6 |year=1977 |pmid=322789 |doi=}}</ref><ref name="pmid3880635">{{cite journal |author=Llera JL, Levy RC |title=Treatment of cutaneous abscess: a double-blind clinical study |journal=Annals of emergency medicine |volume=14 |issue=1 |pages=15–9 |year=1985 |pmid=3880635 |doi=}}</ref>


To prevent recurrent infections due to ''[[Staphylococcus aureus]]'', consider the following measures:
To prevent recurrent infections due to ''[[Staphylococcus aureus]]'', consider the following measures:

Revision as of 12:14, 2 January 2009

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An abscess is defined as an "accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection."[1]

Treatment

Incision and drainage

The abscess should be treated with incision and drainage followed by loose packing.[2]

Primary closure

Primary closure has been successful when combined with curettage and antibiotics[3] or with curettage alone.[4] However, another randomized controlled trial found primary closure led to 35% failing to heal primarily and primary closure longer median number of days to closure (8.9 versus 7.8).[5]

In anorectal abscesses, primary closure healed faster, but 25% of abscesses healed by secondary healing and recurrence was higher.[6]

Antibiotics

Antibiotics should be considered if there is significant overlying cellulitis. Systematic reviews of relevant studies concluded that:[7][8]

"the current literature does not support the routine practice of prescribing antibiotics after incision and drainage of simple cutaneous abscesses, even in high-MRSA-prevalence areas"
"our conclusions cannot be extrapolated to those cases in which there is a significant degree of overlying cellulitis"

A clinical practice guideline by the Infectious Disease Society of American concludes that "gram stain, culture, and systemic antibiotics are rarely necessary"[9]; however, according the National Guideline Clearinghouse summary of this guideline, the guideline was not a systematic review of the evidence.[10]

A more recent randomized controlled trial confirms these results[11]; although in this trial 87.8% were methicillin-resistant staphylococcus aureus (MRSA) yet the antibiotic used was cephalexin. It is not known if an antibiotic effective against MRSA would have reducted the rate of treatment failures below the 10% failure rate observed in the trial. Older trials also are available.[2][12]

To prevent recurrent infections due to Staphylococcus aureus, consider the following measures:

  • Topical mupirocin applied to the nares.[13] In this randomized controlled trial, patients used nasal mupirocin twice daily 5 days a month for 1 year.[14]
  • Chlorhexidine baths,[15] in a randomized controlled trial, nasal recolonization with S. aureus occurred at 12 weeks in 24% of nursing home residents receiving mupirocin ointment alone (6/25) and in 15% of residents receiving mupirocin ointment plus chlorhexidine baths daily for the first three days of mupirocin treatment (4/27). Although these results did not reach statistical significance, the baths are easy to do.

References

  1. ↑ National Library of Medicine. Abscess. Retrieved on 2007-10-19.
  2. ↑ 2.0 2.1 Macfie J, Harvey J (1977). "The treatment of acute superficial abscesses: a prospective clinical trial". The British journal of surgery 64 (4): 264-6. PMID 322789. [e] Cite error: Invalid <ref> tag; name "pmid322789" defined multiple times with different content
  3. ↑ Abraham N, Doudle M, Carson P (1997). "Open versus closed surgical treatment of abscesses: a controlled clinical trial". The Australian and New Zealand journal of surgery 67 (4): 173-6. PMID 9137156. [e]
  4. ↑ Stewart MP, Laing MR, Krukowski ZH (1985). "Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial". The British journal of surgery 72 (1): 66-7. PMID 3881155. [e]
  5. ↑ Simms MH, Curran F, Johnson RA, et al (1982). "Treatment of acute abscesses in the casualty department". British medical journal (Clinical research ed.) 284 (6332): 1827-9. PMID 6805714. [e]
  6. ↑ Kronborg O, Olsen H (1984). "Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up". Acta Chirurgica Scandinavica 150 (8): 689-92. PMID 6397949. [e]
  7. ↑ Hankin A, Everett WW (2007). "Are antibiotics necessary after incision and drainage of a cutaneous abscess?". Annals of emergency medicine 50 (1): 49-51. DOI:10.1016/j.annemergmed.2007.01.018. PMID 17577944. Research Blogging. PMID 17577944
  8. ↑ Korownyk C, Allan GM (2007). "Evidence-based approach to abscess management". Canadian family physician Médecin de famille canadien 53 (10): 1680–4. PMID 17934031. [e]
  9. ↑ Stevens DL, Bisno AL, Chambers HF, et al (November 2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin. Infect. Dis. 41 (10): 1373–406. DOI:10.1086/497143. PMID 16231249. Research Blogging.
  10. ↑ Anonymous (2005). Practice guidelines for the diagnosis and management of skin and soft-tissue infections.. National Guidelines Clearinghouse.
  11. ↑ Rajendran PM, Young D, Maurer T, et al (2007). "Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection". Antimicrob. Agents Chemother. 51 (11): 4044–8. DOI:10.1128/AAC.00377-07. PMID 17846141. Research Blogging.
  12. ↑ Llera JL, Levy RC (1985). "Treatment of cutaneous abscess: a double-blind clinical study". Annals of emergency medicine 14 (1): 15–9. PMID 3880635. [e]
  13. ↑ van Rijen M, Bonten M, Wenzel R, Kluytmans J (2008). "Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers". Cochrane Database Syst Rev (4): CD006216. DOI:10.1002/14651858.CD006216.pub2. PMID 18843708. Research Blogging.
  14. ↑ Raz R, Miron D, Colodner R, Staler Z, Samara Z, Keness Y (1996). "A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection.". Arch Intern Med 156 (10): 1109-12. PMID 8638999.
  15. ↑ Watanakunakorn C, Axelson C, Bota B, Stahl C (1995). "Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents.". Am J Infect Control 23 (5): 306-9. PMID 8585642.
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