Skin abscess: Difference between revisions
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==Management== | ==Management== | ||
*[[Incision and drainage]] | *[[Incision and drainage]] | ||
*[[Antibiotics]] | |||
**[[TMP/SMX]] x 5 days (all abscesses)<ref>EBQ:TMP-SMX vs Placebo for Uncomplicated Skin Abscess</ref> | |||
**Consider more aggressive antibiotic treatment if concomitant [[cellulitis]] | |||
==Disposition== | ==Disposition== | ||
Revision as of 12:13, 28 April 2016
Background
Methicillin-resistant Staphylococcus aureus (MRSA) is a well known cause of many abscesses in the ED being the most common cause of purulent skin and soft-tissue infections.[1][2][3] Treatment for cutaneous abscesses has been incision and drainage with antibiotics generally reserved for those that also had associated cellulitis. This multicenter, double-blind, randomized Controlled Trial of 5 US EDs with >1200 patients challenges the traditional dogma of no antibiotics for simple small uncomplicated abscesses that can be drained. For abscess of median size, 2.5 x 2.0 x 1.5cm that underwent I&D and co-administration of 5 days of TMP/SMX, cure rates were 80.5% vs 73.6% with placebo and I&D.[4]
Clinical Features
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Diagnosis
Work-up
- Ultrasound can be helpful
Evaluation
- Generally clinical diagnosis, may be assisted by ultrasound (above)
Management
- Incision and drainage
- Antibiotics
- TMP/SMX x 5 days (all abscesses)[8]
- Consider more aggressive antibiotic treatment if concomitant cellulitis
Disposition
See Also
External Links
References
- ↑ Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.
- ↑ Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.
- ↑ Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011
- ↑ Talan DA et al.. "Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess". NEJM. 2016. 374(9):823-832. [EBQ:TMP-SMX vs Placebo for Uncomplicated Skin Abscess|Bactrim and I&D NEJM]]
- ↑ Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.
- ↑ Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.
- ↑ Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011
- ↑ EBQ:TMP-SMX vs Placebo for Uncomplicated Skin Abscess