Abscess Incision and Drainage

Fitch, Michael T.; Manthey, David; McGinnis, Henderson D.; Nicks, Bret A.; Pariyadath, Manoj

doi:10.1056/nejmvcm071319

Cited by 57 publications

(16 citation statements)

References 11 publications

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“…Before initiation of the trial, trial personnel underwent standardized training on the general technique 17 and trial-specific procedures for incision and drainage (see the Supplementary Appendix). Using double-blind, Web-based randomization, we assigned participants in a 1:1 ratio to a 7-day course of trimethoprim–sulfamethoxazole (four single-strength pills, each containing 80 mg of trimethoprim and 400 mg of sulfamethoxazole, twice daily) or placebo (four pills containing microcrystalline cellulose, twice daily).…”

Section: Methodsmentioning

confidence: 99%

Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess

et al. 2016

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BACKGROUND U.S. emergency department visits for cutaneous abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained abscess is unclear. METHODS We conducted a randomized trial at five U.S. emergency departments to determine whether trimethoprim–sulfamethoxazole (at doses of 320 mg and 1600 mg, respectively, twice daily, for 7 days) would be superior to placebo in outpatients older than 12 years of age who had an uncomplicated abscess that was being treated with drainage. The primary outcome was clinical cure of the abscess, assessed 7 to 14 days after the end of the treatment period. RESULTS The median age of the participants was 35 years (range, 14 to 73); 45.3% of the participants had wound cultures that were positive for MRSA. In the modified intention-to-treat population, clinical cure of the abscess occurred in 507 of 630 participants (80.5%) in the trimethoprim–sulfamethoxazole group versus 454 of 617 participants (73.6%) in the placebo group (difference, 6.9 percentage points; 95% confidence interval [CI], 2.1 to 11.7; P = 0.005). In the per-protocol population, clinical cure occurred in 487 of 524 participants (92.9%) in the trimethoprim–sulfamethoxazole group versus 457 of 533 participants (85.7%) in the placebo group (difference, 7.2 percentage points; 95% CI, 3.2 to 11.2; P<0.001). Trimethoprim–sulfamethoxazole was superior to placebo with respect to most secondary outcomes in the per-protocol population, resulting in lower rates of subsequent surgical drainage procedures (3.4% vs. 8.6%; difference, −5.2 percentage points; 95% CI, −8.2 to −2.2), skin infections at new sites (3.1% vs. 10.3%; difference, −7.2 percentage points; 95% CI, −10.4 to −4.1), and infections in household members (1.7% vs. 4.1%; difference, −2.4 percentage points; 95% CI, −4.6 to −0.2) 7 to 14 days after the treatment period. Trimethoprim–sulfamethoxazole was associated with slightly more gastrointestinal side effects (mostly mild) than placebo. At 7 to 14 days after the treatment period, invasive infections had developed in 2 of 524 participants (0.4%) in the trimethoprim–sulfamethoxazole group and in 2 of 533 participants (0.4%) in the placebo group; at 42 to 56 days after the treatment period, an invasive infection had developed in 1 participant (0.2%) in the trimethoprim–sulfamethoxazole group. CONCLUSIONS In settings in which MRSA was prevalent, trimethoprim–sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00729937.)

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Section: Methodsmentioning

confidence: 99%

Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess

et al. 2016

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“…10 Topical antibiotic use has limited benefits and is not recommended. 20 It is important that patients presenting with CA-MRSA be initiated on appropriate treatment as early as possible. Pangilinan et al 25 performed a literature review to determine the outcome and efficacy of various topical antibiotic treatment options for SSTIs.…”

Section: Antimicrobial Usementioning

confidence: 99%

“…This includes redness, swelling, or the development of systemic symptoms. 20 Regardless of whether the abscess wound is packed or not, a follow-up visit should be scheduled within 48 hours of the initial visit to confirm adequate response to therapy. 10…”

Section: Wound Carementioning

confidence: 99%

Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections

Estes¹

2011

Critical Care Nursing Quarterly

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With the emergence and rising prevalence of methicillin-resistant Staphylococcus aureus among individuals in the community, it is imperative to standardize patient care and develop best practices among health care providers. Evidence-based standard patient care guidelines for community-acquired methicillin-resistant S aureus skin and soft tissue infections have the potential to positively impact patient outcomes, decrease health risk, reduce hospitalization from insufficient treatment, and decrease or even prevent further transmission to unaffected individuals. Emergency department providers are in a unique position to lead in the management and prevention of skin and soft tissue infections. It is essential that community-acquired methicillin-resistant S aureus skin and soft tissue infections are consistently treated by evidence-based treatment standards, especially with the growing number of pathogens displaying resistance to antibiotics, rising mortality, rapid spread of antimicrobial resistant microbes, and the escalating health care costs. The purpose of this literature review is to provide health care providers with current evidence-based health care guidelines for the treatment and management of community-acquired methicillin-resistant S aureus skin and soft tissue infections.

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“…A step-by-step, descriptive video clip of how to perform incision and drainage can be viewed at http://content.nejm.org/cgi/content/ short/357/19/e20 [58].…”

Section: Drainage and Debridementmentioning

confidence: 99%

“…Although it is recommended [58], the additional clinical utility of irrigating the abscess cavity is unknown.…”

Section: Drainage and Debridementmentioning

confidence: 99%