Uncomplicated Skin Abscesses Research Articles

Journal Scan: “Drain-O-Mycin” Still Preferred for Uncomplicated Skin Abscess in MRSA Era

Journal Scan: “Drain-O-Mycin” Still Preferred for Uncomplicated Skin Abscess in MRSA Era

Another Study of Antibiotics for Uncomplicated Skin Abscesses

In a previous study of antibiotic therapy for adults with uncomplicated skin abscesses who underwent incision and drainage, the clinical cure rates

7: Efficacy of Topical Lidocaine Preparations In Spontaneous Rupture of Uncomplicated Skin Abscesses

7: Efficacy of Topical Lidocaine Preparations In Spontaneous Rupture of Uncomplicated Skin Abscesses

Randomized Controlled Trial of Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses in Patients at Risk for Community-Associated Methicillin-Resistant Staphylococcus aureus Infection

Community-associated methicillin-resistant Staphylococcus aureus is now the leading cause of uncomplicated skin abscesses in the United States, and the role of antibiotics is controversial. We evaluate whether trimethoprim-sulfamethoxazole reduces the rate of treatment failures during the 7 days after incision and drainage and whether it reduces new lesion formation within 30 days. In this multicenter, double-blind, randomized, placebo-controlled trial, we randomized adults to oral trimethoprim-sulfamethoxazole or placebo after uncomplicated abscess incision and drainage. Using emergency department rechecks at 2 and 7 days and telephone follow-up, we assessed treatment failure within 7 days, and using clinical follow-up, telephone follow-up, and medical record review, we recorded the development of new lesions within 30 days. We randomized 212 patients, and 190 (90%) were available for 7-day follow-up. We observed a statistically similar incidence of treatment failure in patients receiving trimethoprim-sulfamethoxazole (15/88; 17%) versus placebo (27/102; 26%), difference 9%, 95% confidence interval -2% to 21%; P=.12. On 30-day follow-up (successful in 69% of patients), we observed fewer new lesions in the antibiotic (4/46; 9%) versus placebo (14/50; 28%) groups, difference 19%, 95% confidence interval 4% to 34%, P=.02. After the incision and drainage of uncomplicated abscesses in adults, treatment with trimethoprim-sulfamethoxazole does not reduce treatment failure but may decrease the formation of subsequent lesions.

331: Prospective Randomized Trial of Trimethoprim-Sulfamethoxazole vs Placebo on 30-Day Recurrence Rates for Uncomplicated Skin Abscesses in Patients at Risk for Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infection: An Interim Analysis

Community-acquired methicillin-resistant Staphylococcus aureus (cMRSA) skin and soft tissue infections are becoming increasingly prevalent in the patient population in the emergency department. Currently, conflicting data exist on the utility of antibiotics to treat uncomplicated cMRSA abscesses. No previous studies have investigated the recurrence rates of abscesses after antibiotics. The primary outcome was to determine whether administration of trimethoprim-sulfamethoxazole, in addition to incision and drainage, may prevent recurrence of abscesses at 30 days. A subset analysis was performed to evaluate patients who were MRSA positive and patients with abscesses with overlying cellulitis.

335: Double-Blind, Randomized, Controlled Multi-Center Trial of Antibiotic Treatment for Uncomplicated Skin Abscesses in Patients at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection: An Interim Analysis

335: Double-Blind, Randomized, Controlled Multi-Center Trial of Antibiotic Treatment for Uncomplicated Skin Abscesses in Patients at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection: An Interim Analysis

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Fatal Septic Thrombosis of the Superior Sagittal Sinus After Face-lift Surgery Caused by Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i>

Is antimicrobial therapy needed to manage uncomplicated skin and soft-tissue abscesses?

Evaluation of: Rajendran PM, Young D, Maurer T et al. 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, 4044–4048 (2007).Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections occur across a wide spectrum of epidemiologic groups, which range from medically underserved urban dwellers to professional athletes. CA-MRSA primarily causes skin and soft-tissue infections but it can also cause severe invasive disease, including necrotizing pneumonia and necrotizing fasciitis. In light of CA-MRSA’s proclivity to cause skin and soft-tissue abscesses and its capacity to inflict severe illness, investigators have been prompted to revisit the question of whether adjunctive antimicrobial therapy is necessary in the management of uncomplicated abscesses. This article evaluates the findings of a recently published randomized, double-blind, placebo-controlled trial that aims to determine whether ‘standard-of-care’ antimicrobial therapy is needed after adequate surgical incision and drainage of uncomplicated skin and soft-tissue abscesses.

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

Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft tissue infections, may no longer be appropriate for these infections because of the increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. We conducted a randomized, double-blind trial of 166 outpatient subjects comparing placebo to cephalexin at 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. S. aureus was isolated from 70.4% of abscess cultures. Of the isolates tested 87.8% were MRSA, 93% of which were positive for Panton-Valentine leucocidin genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 to 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval, 0.74 to 0.91) in the 82 cephalexin recipients (difference in the two proportions, 0.0006; 95% confidence interval, -0.0461 to 0.0472; P = 0.25). The 90.5% cure rate observed in the placebo arm and 84.1% cure rate observed in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

Antibiotic Use in The Treatment of Soft Tissue Abscesses: A Survey of Current Practice

Surgical InfectionsVol. 8, No. 2 Letter to The EditorAntibiotic Use in The Treatment of Soft Tissue Abscesses: A Survey of Current PracticePriya M. Rajendran, David M. Young, Toby Maurer, Henry F. Chambers, Mark A. Jacobson, and Hobart W. HarrisPriya M. RajendranSearch for more papers by this author, David M. YoungSearch for more papers by this author, Toby MaurerSearch for more papers by this author, Henry F. ChambersSearch for more papers by this author, Mark A. JacobsonSearch for more papers by this author, and Hobart W. HarrisSearch for more papers by this authorPublished Online:16 Apr 2007https://doi.org/10.1089/sur.2006.028AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Antibiotic Use in The Treatment of Soft Tissue Abscesses: A Survey of Current Practice." , 8(2), pp. 237–238FiguresReferencesRelatedDetailsCited bySkin and Soft Tissue InfectionsPediatric Clinics of North America, Vol. 60, No. 5Abscess Volume and Ultrasound Characteristics of Community-Associated Methicillin-Resistant Staphylococcus aureus InfectionPediatric Emergency Care, Vol. 29, No. 2Emergency Department Treatment Failures for Skin Infections in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureusPediatric Emergency Care, Vol. 27, No. 1Emergency Management of Pediatric Skin and Soft Tissue Infections in the Community-associated Methicillin-resistant Staphylococcus aureus EraAcademic Emergency Medicine, Vol. 17, No. 2When Antibiotics are UnnecessaryDermatologic Clinics, Vol. 27, No. 1Management and control strategies for community-associated methicillin-resistant Staphylococcus aureus2 June 2008 | Expert Opinion on Pharmacotherapy, Vol. 9, No. 9Randomized, 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 InfectionAntimicrobial Agents and Chemotherapy, Vol. 51, No. 11 Volume 8Issue 2Apr 2007 InformationMary Ann Liebert, Inc.To cite this article:Priya M. Rajendran, David M. Young, Toby Maurer, Henry F. Chambers, Mark A. Jacobson, and Hobart W. Harris.Antibiotic Use in The Treatment of Soft Tissue Abscesses: A Survey of Current Practice.Surgical Infections.Apr 2007.237-238.http://doi.org/10.1089/sur.2006.028Published in Volume: 8 Issue 2: April 16, 2007PDF download

The Limited Role of Microbiological Culture and Sensitivity in the Management of Superficial Soft Tissue Abscesses

The aim of this study was to assess the role of the routine practice of microbial culture and sensitivity at incision and drainage of superficial soft tissue abscesses. The case notes of 162 consecutive patients, selected from the microbiology database over a period of 1 year, were reviewed. All had incision and drainage of superficial soft tissue abscesses and included perianal, pilonidal, axillary, and breast abscesses. Patients with chronic wounds, recurrent abscesses, diabetes, pregnancy, and immunosuppression were excluded. The impact of pus culture and sensitivity (C/S) on management and clinical outcome was documented. Out of 162 patients, 97 were male (59.8%) and 65 were female (40.1%). Only 115 (70.9%) yielded positive cultures and 47 (29.1%) were sterile. The cultured microbial flora was predictable and sensitive to empirical antibiotics. In four patients, the results of microbial culture sensitivity showed microbial resistance to empirical antibiotics; however, it did not affect the management or the outcome for these patients. The routine practice of sending swabs for C/S after incision and drainage of superficial soft tissue abscesses does not contribute significantly towards patient management. Most patients are already on antibiotics prior to the referral and in the remainder, surgeons start antibiotics empirically. These broad-spectrum antibiotics cover the common pathogens involved, and there is no significant change in the antibiotic treatment after reviewing the culture reports following incision and drainage of uncomplicated superficial skin abscesses.