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    Cutaneous Abscess – Management

    Infections

    Last Updated Nov 20, 2017
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    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 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).

    Recommended Treatment

    • 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?

    Justification

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

    High

    Related Information

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    RELEVANT CLINICAL RESOURCES

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    RELEVANT VIDEO

    10:13

    Abscess Incision and Drainage

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