How Do You Treat an Abscess in the Era of Increased Community-associated Methicillin-resistant Staphylococcus Aureus (MRSA)?

Schmitz, Gillian

doi:10.1016/j.jemermed.2011.01.027

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…However, successful eradication of S. aureus by neutrophils exists in a balance, with staphylococci actively subverting neutrophil responses in order to persist in vivo (9,53). The presence of abscesses during staphylococcal bacteremia is clinically significant, since hematogenous spread from the abscess is well documented (54,57,58).…”

Section: Discussionmentioning

confidence: 99%

Superantigens Subvert the Neutrophil Response To Promote Abscess Formation and Enhance Staphylococcus aureus SurvivalIn Vivo

Gilmore

Szabo

et al. 2014

Infect Immun

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Section: Discussionmentioning

confidence: 99%

Superantigens Subvert the Neutrophil Response To Promote Abscess Formation and Enhance Staphylococcus aureus SurvivalIn Vivo

Gilmore

Szabo

et al. 2014

Infect Immun

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“…This was surprising, since according to the CDC (2007) and others Popvich et al, 2008;Schmitz, 2011), patients should be instructed to return within 2 days of initial treatment for a wound check. This was surprising, since according to the CDC (2007) and others Popvich et al, 2008;Schmitz, 2011), patients should be instructed to return within 2 days of initial treatment for a wound check.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, it has been estimated that antibiotics were prescribed for up to 78% of ED visits for SSTIs (Krucke, Grimes, Grimes, & Dang, 2009). This belief is supported by several studies that demonstrate increased rate of successful treatment with I&D alone even in the era of CA-MRSA (Breen, 2010;Schmitz, 2011). This belief is supported by several studies that demonstrate increased rate of successful treatment with I&D alone even in the era of CA-MRSA (Breen, 2010;Schmitz, 2011).…”

Section: Significance Of the Problemmentioning

confidence: 95%

“…For example, the utility of wound cultures, routine wound packing, the accuracy of the clinical assessment of the likelihood of CA-MRSA infections, the decision to prescribe antibiotics in conjunction with I&D, and whether special instructions for patient follow-up should be given have all been debated (Abrahamian et al, 2008;Schmitz, 2011). For example, the utility of wound cultures, routine wound packing, the accuracy of the clinical assessment of the likelihood of CA-MRSA infections, the decision to prescribe antibiotics in conjunction with I&D, and whether special instructions for patient follow-up should be given have all been debated (Abrahamian et al, 2008;Schmitz, 2011).…”

Section: Significance Of the Problemmentioning

confidence: 99%

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Skin and Soft Tissue Infection Management, Outcomes, and Follow-Up in the Emergency Department of an Urban Academic Hospital

Seeleang

Manning

Saks

et al. 2014

Advanced Emergency Nursing Journal

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Skin and soft tissue infections (SSTIs) are among the most common infections treated by emergency department clinicians. The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) as the cause of these infections prompted the Centers for Disease Control and Prevention and the Infectious Disease Society of America to publish guidelines for the outpatient management of SSTIs. This study describes the management and outcomes of emergency department patients treated for uncomplicated SSTIs who returned within 30 days of the initial visit. The study found that of 857 eligible patients, only 17.6% returned and of these, 80% had their wound checked or packing removed. The clinicians prescribed antibiotics for the majority of patients, and the selection of antibiotics typically was active against CA-MRSA. Of 91 lesions drained, 24 specimens were obtained for culture and sensitivity. The majority of the initial treatment of patients consisted of incision and drainage with antibiotic prescription.

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“…Although the 2011 Infectious Diseases Society of America guidelines recommend wound cultures in certain circumstances, the routine use of wound cultures in uncomplicated abscesses in otherwise healthy individuals is often unnecessary in the ED 20. While the prevalence of MRSA is variable geographically, it has become the most common cause of skin and soft tissue infections and is often treated empirically.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers' Practice Patterns

Schmitz¹,

Goodwin²,

Singer³

et al. 2013

WestJEM

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IntroductionCutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing. Although guidelines exist to support clinician management of abscesses, they do not clearly specify these additional interventions. This study sought to describe the ED treatments administered to adults with uncomplicated superficial cutaneous abscesses, defined as purulent lesions requiring incision and drainage that could be managed in an ED or outpatient setting.Methods:Four hundred and seventy-four surveys were distributed to 15 EDs across the United States. Participants were queried about their level of training and practice environment as well as specific questions regarding their management of cutaneous abscesses in the ED.Results:In total, 350 providers responded to the survey (74%). One hundred eighty-nine respondents (54%) were attending physicians, 135 (39%) were residents, and 26 (7%) were midlevel providers. Most providers (76%) used narcotics for pain management, 71% used local anesthetic over the roof of the abscess, and 60% used local anesthetic in a field block for pain control. More than 48% of responders routinely used irrigation after (I&D). Eighty-five percent of responders used a linear incision to drain the abscess and 91% used packing in the wound cavity. Thirty-two percent routinely sent wound cultures and 17% of providers routinely prescribed antibiotics. Most providers (73%) only prescribed antibiotics if certain historical factors or physical findings were present on examination. Antibiotic treatment, if used, favored a combination of 2 or more drugs to cover both Streptococcus and methicillin-resistant Staphylococcus aureus (47%). Follow-up visits were most frequently recommended at 48 hours unless wound was concerning and required closer evaluation.Conclusion:Variability exists in the treatment strategies for abscess care. Most providers used narcotic analgesics in addition to local anesthetic, linear incisions, and packing. Most providers did not irrigate, order wound cultures, or routinely prescribe oral antibiotics unless specific risk factors or physical signs were present. Limited evidence is available at this time to guide these treatment strategies.

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How Do You Treat an Abscess in the Era of Increased Community-associated Methicillin-resistant Staphylococcus Aureus (MRSA)?

Cited by 10 publications

References 23 publications

Superantigens Subvert the Neutrophil Response To Promote Abscess Formation and Enhance Staphylococcus aureus SurvivalIn Vivo

Superantigens Subvert the Neutrophil Response To Promote Abscess Formation and Enhance Staphylococcus aureus SurvivalIn Vivo

Skin and Soft Tissue Infection Management, Outcomes, and Follow-Up in the Emergency Department of an Urban Academic Hospital

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers' Practice Patterns

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