Drainage Of Skin Abscesses Research Articles

Epidemiological assessment of non-tuberculous mycobacterial cervicofacial lymphadenitis: A PHIS database study

ObjectiveCervicofacial lymphadenitis caused by non-tubercular mycobacterial (NTM) infections has the highest infection rate in children. Our objective was to assess patient demographics, treatment methods, and the impact of weather and geography on the incidence of disease in patients with NTM cervicofacial lymphadenitis. MethodsThe Pediatric Health Information System (PHIS) database was queried for data on all patients diagnosed with concurrent cervicofacial lymphadenopathy and NTM infection from 2004 to 2022. We assessed the association between weather patterns and NTM cervicofacial lymphadenitis by collecting monthly weather data from the NOAA National Center for Environmental Information. Incidence rates were calculated by dividing the number of cases by the total hospital discharges during the study period. ResultsAmong 47 PHIS hospitals, there were 992 diagnoses of NTM cervicofacial lymphadenitis. The average age at diagnosis was 2 [IQR, 2–4], with 59 % female. Drainage of skin abscesses or lesions was performed for 93 (9.4 %) patients, while 15 (1.5 %) had an excisional procedure of the CPT codes assessed. The most common antibiotics utilized were cephalosporins (28 %), macrolides (27 %), and rifampin (12 %). The most common treatment method was surgery with antibiotics (37 %) followed by no treatment at all (35 %), surgery alone (17 %), and antibiotics alone (10 %). Of the 28 states included in the analysis, Washington (IR: 3.5) and Nebraska (IR: 3.3) had the highest incidence rates (IR) of NTM cervical lymphadenitis. The cases were relatively equally distributed across the different weather seasons within each U.S. geographic region. However, the overall average wind speed was weakly associated with increasing the risk of diagnosis when utilizing a mixed effect zero-inflated negative binomial model (Incidence Ratio: 1.07, 95 % CI: (1.01–1.14), p = 0.035). ConclusionsOur results indicate that the most common treatment method utilized in patients within our cohort with NTM cervicofacial lymphadenitis was the concurrent use of surgery and antibiotics. Our results also indicate there may be variation in the incidence rate among different states, but additional studies are needed as our cohort only included approximately 50 % of states within the U.S.

Loop Technique for Skin Abscess Drainage

Abscess management in the emergency department (ED) is continually evolving, with some studies questioning the need for packing or antibiotics. The

Meta-Analysis Favors Antibiotics After Drainage of Skin Abscesses

Prior to 2016, trials and meta-analyses suggested that antibiotics were not beneficial as adjunctive therapy in patients treated with incision and

Adenoma Detection Rate in a Small Ambulatory Surgery Center

Introduction: Colonoscopy is the most common method to diagnose colon cancer. Colon cancer is the second leading cause of cancer death in our country. The adenoma detection rate has been recommended as one of the main quality indicator. The adenoma detection rate (ADR) is 25%. ADR is 30 % for men and 20% for women. ADR is the quality indicator with the strongest association to post-colonoscopy colorectal cancer or missed colorectal cancer. Improved adenoma detection rate will decrease the incidence of post-colonoscopy colorectal cancer. Newer studies have shown that for each 1% increase in ADR, risk of “missed” CRC decreases by 3%. There are very few studies regarding the adenoma detection rate in Colonoscopy performed in a small ambulatory surgery center. Methods: All patients who underwent screening colonoscopies in our ambulatory surgery center between 2013 to 2015 were included in the data analysis. The ADR is defined as the number of patients out of every 100 undergoing first time screening colonoscopy who have at least one adenoma removed. The withdrawl time was more than 6 minutes in all the screening colonoscopies. The cecal intubation rate was 96.8% in our center. Most of the patient's used split dose colonic prep. The patient's with incomplete colonoscopy secondary to poor prep was excluded from the analysis. Results: There were 4486 procedures performed by two physicians in our ambulatory surgery center. 54.3 % were colonoscopies, 28.8% were upper endoscopies, 0.2 were flexible sigmoidoscopies. 16.6 % were minor surgical procedures like skin abscess drainage, port placement. 616 patient's underwent screening colonoscopies. The mean age of screening colonoscopy group was 58.6 years. Our youngest patient was 50 years old and the oldest was 79 years old. 58.2 % were females and 41.8% were males. 291 patients were found to have adenoma giving adenoma detection rate of 47%. Conclusion: High adenoma detection rate can be achieved in small community ambulatory surgery center provided high quality measures like high cecal intubation rate, good quality prep, increased withdrawl time are achieved diligently. Newer technologies like Fusion scope by Endochoice will also increase the adenoma detection rate. ADR as a quality measure are now being tracked by Medicare and commercial insurance companies. Added pay for performance ADR benchmarks being considered and granted by some commercial payers.

Antibiotic Treatment Duration Following Skin Abscess Drainage

Staphylococcus aureus , both methicillin-sensitive (MSSA) and methicillin-resistant (MRSA), causes the majority of skin and soft tissue infections in adults and children. Incision and drainage (ID 56:283), but the optimal duration of antibiotic therapy, if prescribed following I&D, has …

Injectable Lidocaine Provides Similar Analgesia Compared to Transdermal Lidocaine/Tetracaine Patch for the Incision and Drainage of Skin Abscesses: A Randomized, Controlled Trial

BackgroundLocal anesthesia used for incision and drainage of abscesses is known to be painful. Study ObjectiveWe studied the analgesia provided by a lidocaine/tetracaine patch compared to injectable lidocaine during incision and drainage (I&D) of skin abscesses. MethodsThis was a prospective, double-blind, randomized, controlled trial carried out in the Emergency Department (ED) of an adult tertiary referral center. Adult patients with a skin abscess in need of I&D were randomized to one of two groups. One group received a lidocaine/tetracaine patch and injectable normal saline for anesthesia. The second group received a placebo patch and injectable 1% lidocaine. A visual analog pain scale was used to record the patient's pain level prior to treatment, during the procedure, and after I&D. ResultsThere were 20 patients enrolled in the study, including 12 randomized to the lidocaine/tetracaine patch and 8 to the injectable lidocaine. Pain scores preprocedure were similar in the two groups. Pain scores during I&D and postprocedure were compared between groups using a paired t-test. Patients receiving injectable lidocaine experienced pain that was similar (50.1 ± 5.9 mm; 95% confidence interval [CI] 45.2–55.1) to those receiving the transdermal lidocaine/tetracaine patch (60.1 mm ± 11.0; 95% CI = 55.2–68.1), p = 0.04, with a power of 80% to detect a difference of 20 mm at p ≤ 0.05; although this was statistically significant, it was not clinically significant. There was also no statistical difference between the two groups in the postprocedure pain scores (p = 0.65). ConclusionLocal injection of lidocaine provided clinically similar analgesia compared to the lidocaine/tetracaine patch during I&D of skin abscesses in the ED. Pain at presentation and after the procedure was similar in both groups. Emergency physicians should continue to use a local injected anesthetic for I&D of skin abscesses until a less painful alternative is identified.

145 Injectable Lidocaine Provides Superior Analgesia Compared to Transdermal Lidocaine/Tetracaine Patch for the Incision and Drainage of Skin Abscesses

Emergency department (ED) visits for skin abscesses are on the rise and treatment is incision and drainage (I&D). Typically local anesthesia is administered prior to incision using injectable lidocaine but this is known to cause considerable pain. A transdermal patch containing lidocaine and tetracaine (Synera®) provides local anesthesia without injection. We chose to compare the lidocaine/tetracaine patch to injectable lidocaine for pain control during I&D of skin abscesses.