Drainage Of Soft Tissue Abscesses Research Articles

1239 Microbiology, Culture and Sensitivity Analysis During Drainage of Non-Perianal Soft-Tissue Abscesses: Do We Review the Results and How Often Do They Change Management?

Abstract Aim The utility in obtaining microbiology, culture, and sensitivity (MC&S) specimens during drainage of soft-tissue abscesses is controversial. This study aimed to determine if routine MC&S analysis changed management after drainage of non-perianal abscesses. Method A retrospective review was undertaken of consecutive patients undergoing drainage for non-perianal superficial abscesses between July and November 2021. Data recorded included whether an MC&S specimen was taken, the result, any antimicrobial treatment and clinical outcome. Using the Auditing functions inbuilt to the software, whether the surgical team had subsequently reviewed the result was also determined. Results 76 patients underwent abscess drainage, located in the pilonidal region (32%), axillary (24%), buttock (24%), groin (11%), neck (5%) and trunk (5%). MC&S was sent from 52 cases (69%). Results were reviewed by the surgical team in 6 cases (11%). Samples were positive in 34 cases (65%). Mixed organisms were the most common positive finding (28 cases) and sensitivity was not performed on these samples. Methicillin-sensitive S aureus was cultured from 4 cases (8%), Methicillin-resistant S aureus from 1 case (2%) and Staphylococcus lugdenensis from 1 case (2%). Post-operative antibiotics were prescribed for 25 patients. 4 patients required a further course of antibiotics postoperatively and in all these cases MC&S was taken but showed no growth. Conclusions Few MC&S results were reviewed by the surgical team and MC&S results did not guide management in any case. These results support the hypothesis that routine MC&S sampling is not required for typical abscesses in low-risk patients.

Same-day discharge after incision and drainage of soft-tissue abscess in diaper-age children is safe and effective

Many pediatric centers admit patients following incision and drainage (I&D) of soft-tissue abscesses. The purpose of this study is to assess the safety and efficacy of the same-day discharge following I&D. Retrospective review was performed of children aged 3months-4years who underwent operative I&D of an abscess followed by same-day discharge. Patients receiving antibiotics within 2weeks of presentation were excluded. Treatment failure was defined as readmission or repeat procedure related to the initial abscess. Statistical analysis was performed using Wilcoxon Rank-Sum and Fisher's Exact tests. There were 442 procedures performed in 408 patients. Mean age was 1.8years. Fever was noted in 25.8%. Of those who had a white blood cell (WBC) count drawn, 59.7% had leukocytosis. Mean time from procedure to discharge was 2.3h, and 85.0% were discharged with oral antibiotics. Treatment failure occurred in four (0.9%) and ten (2.3%) patients at 14 and 30days, respectively. Mean WBC count was higher in the 14-day treatment failure group (24.1 versus 16.3; p = 0.10). In patients with leukocytosis, there were 2 (1.4%) treatment failures compared to none in those without leukocytosis. Same-day discharge after I&D of abscess in diaper-age children is safe and effective.

Staphylococcal Sepsis with Multiple Abscesses, Urinary Tract Infection, and Bilateral Renal Vein Thrombosis in a Patient with Uncontrolled Diabetes Mellitus

We report a case of staphylococcal sepsis with vascular complications including peripheral emboli and renal vein thrombosis. Bilateral renal vein thrombosis has not been reported as a complication of Staphylococcus aureus (SA) axillary abscess. Uncontrolled diabetes was the only detected predisposing medical condition. The patient was treated successfully with incision and drainage of soft-tissue abscesses and intravenous antibiotic for six weeks and with anticoagulation for renal vein thrombosis.

A comparison of traditional incision and drainage versus catheter drainage of soft tissue abscesses in children

Background/Purpose Soft tissue infections are increasingly being seen for surgical management, which is associated with painful dressing changes, lost days at school, time away from family, and scarring, which can have a great impact on both child and caretaker. We postulated that a drainage technique using a modified Pezzar catheter would be associated with shorter hospital stays and less wound care. Methods A consecutive series of 400 children with soft tissue abscesses was evaluated from April 2007 to October 2008. Children were managed according to the operating surgeon's preference. Children remained in the hospital until they were afebrile and the wounds could be adequately managed at home. Drains were removed 1 week after surgery in clinic. Results There were no treatment failures. Three hundred twenty-two children were managed with standard incision and drainage (I&D) and 78 patients with catheter drainage. Twenty-two children in the catheter drainage group (28%) required hospitalization of greater than 1 day compared with 151 children (47%) in the I&D group ( P = .001, Fisher exact test). Thirty-four percent of the children managed with I&D required packing at home, which was required in none of the patients managed with catheter drainage. Patient age, catheter drainage, and site of the lesion were associated independently with shorter hospital stays. Conclusion We conclude that catheter drainage of soft tissue abscesses in children is safe and effective. Catheter drainage is associated with a decreased hospital stay. Other factors related to shorter hospital stays include age of the patient and the site of soft tissue abscess.

Cervicofacial actinomycosis: Diagnosis and management

Cervicofacial actinomycosis is an uncommon but fascinating infection of the head and neck. Most cases are odontogenic in origin and occur predominantly in immunocompetent individuals. Causative microorganisms are generally of low pathogenicity and cause disease only in the setting of antecedent tissue injury. The disease process is characterized by the formation of abscesses, fibrosis and woody induration of tissues, and draining sinuses that discharge "sulfur granules." Cultural isolation of Actinomyces species from clinical specimens, or microscopic visualization of gram-positive, non-acid-fast, thin, branching filaments in cytologic aspirates or histopathologic sections are the best methods of diagnosis of cervicofacial actinomycosis. Penicillin is the drug of choice and is usually administered for 2 to 12 months, although short-course treatment may cure uncomplicated infection. Surgical therapy is often indicated for curettage of bone, resection of necrotic tissue, excision of sinus tracts, and drainage of soft tissue abscesses. The prognosis for treated infection is excellent.

Surgical implications of chronic granulomatous disease

BACKGROUND: Chronic granulomatous disease (CGD) of childhood is a rare congenital ahnormality of the phagocyte NADPH oxidase system. Affected neutrophils and macrophages have an ineffective respiratory burst and cannot destroy certain phagocytized bacteria and fungi. CGD patients usually present with recurrent pyogenic and fungal infections. Catalase-positive bacteria are frequently involved, since they metabolize the hydrogen peroxide they produce, making it unavailable for augmentation of microbicidal activity in CGD neutrophils. AI&ted patients also have a tendency to form granulomas, which can lead to obstruction of the gastrointestinal and genitourinary tracts. METHODS: Charts of 10 patients with CGD were reviewed for age at diagnosis, surgical procedures, complications of these procedures, and medical treatment. RESULTS: Eight of the 10 children were male. The average age at first presentation was 18 months (range 2 days to 9.8 years). Each child developed a mean of 9.9 infections and an average of 1.4 infections per year. All required surgical procedures, with an average of 2.9 procedures each. Five children had operative procedures for infections that preceded the diagnosis of CGD. The procedures performed most frequently were incision and drainage of soft-tissue abscesses (7) or perirectal abscess (3), thoracentesis (3), and bronchoscopy (3). Three children had poor wound healing following surgery. Two developed partial gastric outlet obstruction which resolved with antibiotic therapy. One developed granulomatous cystitis with obstruction which responded to antibiotics. CONCLUSIONS: Since patients with undiagnosed CGD may present with surgical problems, surgeons need to be familiar with this condition. The diagnosis should be suspected in children who have recurrent or unusual infections or unexplained problems with wound healing.

Surgical intervention in children with human immunodeficiency virus infection

Twenty-one children with human immunodeficiency virus (HIV) infection required surgical intervention during the course of their disease. There were 11 females and 10 males (age range, 3 months to 6 years). The children underwent 54 operative procedures after diagnosis of their disease. These included placement of central venous catheter (23 patients), open lung biopsy (11), incision and drainage of perirectal abscess (4), incision and drainage of soft tissue abscess (5), myringotomy (2), diverting colostomy (3), Nissen fundoplication (1), and other (5). All 21 patients had clinical AIDS by the Centers for Disease Control CDC classification. To date, there have been 12 deaths in the 21 patients (57%) due to progressive deterioration with the patient's disease. Most procedures were adjuncts for diagnostic and therapeutic intervention in a population of children with a uniformly fatal disease. The knowledge of various high risk groups for AIDS must heighten the surgeon's awareness to the growing and significant pediatric segment of the HIV population, the complications of their disease, and the surgeon's limited role in treating these problems.