Abscess: Difference between revisions
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imported>Robert Badgett (Text I helped write at WP) |
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===Incision and drainage=== | ===Incision and drainage=== | ||
The abscess should be treated with incision and drainage followed by loose packing.<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> | The abscess should be treated with incision and drainage followed by loose packing.<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> | ||
===Primary closure=== | |||
Primary closure has been successful when combined with [[curettage]] and [[antibiotics]]<ref name="pmid9137156">{{cite journal |author=Abraham N, Doudle M, Carson P |title=Open versus closed surgical treatment of abscesses: a controlled clinical trial |journal=The Australian and New Zealand journal of surgery |volume=67 |issue=4 |pages=173-6 |year=1997 |pmid=9137156 |doi=}}</ref> or with curettage alone.<ref name="pmid3881155">{{cite journal |author=Stewart MP, Laing MR, Krukowski ZH |title=Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial |journal=The British journal of surgery |volume=72 |issue=1 |pages=66-7 |year=1985 |pmid=3881155 |doi=}}</ref> 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).<ref name="pmid6805714">{{cite journal |author=Simms MH, Curran F, Johnson RA, ''et al'' |title=Treatment of acute abscesses in the casualty department |journal=British medical journal (Clinical research ed.) |volume=284 |issue=6332 |pages=1827-9 |year=1982 |pmid=6805714 |doi=}}</ref> | |||
In anorectal abscesses, primary closure healed faster, but 25% of abscesses healed by secondary healing and recurrence was higher.<ref name="pmid6397949">{{cite journal |author=Kronborg O, Olsen H |title=Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 3-year follow-up |journal=Acta Chirurgica Scandinavica |volume=150 |issue=8 |pages=689-92 |year=1984 |pmid=6397949 |doi=}}</ref> | |||
===Antibiotics=== | ===Antibiotics=== | ||
| Line 13: | Line 18: | ||
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> | 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> | ||
To prevent recurrent infections due to ''[[Staphylococcus]]'', consider the following measures: | |||
*Topical [[mupirocin]] applied to the nares.<ref name=Raz1996>{{cite journal | author = Raz R, Miron D, Colodner R, Staler Z, Samara Z, Keness Y | title = A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection. | journal = Arch Intern Med | volume = 156 | issue = 10 | pages = 1109-12 | year = 1996 | id = PMID 8638999}}</ref> In this [[randomized controlled trial]], patients used nasal mupirocin twice daily 5 days a month for 1 year. | |||
*[[Chlorhexidine]] baths,<ref name=Watanakunakorn>{{cite journal | author = Watanakunakorn C, Axelson C, Bota B, Stahl C | title = Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. | journal = Am J Infect Control | volume = 23 | issue = 5 | pages = 306-9 | year = 1995 | id = PMID 8585642}}</ref> 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== | ==References== | ||
<references/> | <references/> | ||
Revision as of 16:14, 11 January 2008
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 more recent randomized controlled trial confirms these results.[9]
To prevent recurrent infections due to Staphylococcus, consider the following measures:
- Topical mupirocin applied to the nares.[10] In this randomized controlled trial, patients used nasal mupirocin twice daily 5 days a month for 1 year.
- Chlorhexidine baths,[11] 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
- ↑ National Library of Medicine. Abscess. Retrieved on 2007-10-19.
- ↑ 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]
- ↑ 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]
- ↑ 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]
- ↑ 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]
- ↑ 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]
- ↑ 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
- ↑ 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]
- ↑ 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.
- ↑ 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.
- ↑ 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.