Skin Abscess

Question 1

How do we source control skin abcess (2)

Answer 1

1. Warm compress (spontaneous drainage)
   - 5-10 min TID to QID
2. Most will require incision and drainage (I&D)
   - Needed so that ABX can access the infection
   - Can quickly improve symptoms. “pus under pressure” leads to pain and fever

Question 2

Who 100% should get ABX added on to their abscess control (5)
Who would you consider adding ABX (2)

Answer 2

• Failed on I&D alone
• Immunocompromise
• Systemic symptoms (eg. fever, tachychardia, leukocytosis)
• Surrounding cellulitis
• Surrounding lymphangitis

Large abscess (over 5cm)
Area where I&D is difficult (i.e hands, feet, face)

Question 3

What did the Gottlieb trial tell us about adding agents with MRSA?

Answer 3

giving ABX with MRSA activity (along with I&D) improves outcomes (more than MSSA ABX)
USA study - likely due to increased MRSA prevalence in USA

Question 4

What are risk factors for MRSA? (4) Would you give ABX that covers it?

Answer 4

**regardless of if they meet ABX criteria - GIVE MRSA ABX

• Crowded living (prison, homeless, indigenous reserve)
• recent hospitalization
• travel to USA
• IV drug user

Question 5

If the patient meets antibiotic criteria (i.e failed I&D, immunocomprimised) and does not have MRSA risk factors, what should you give

Answer 5

Give MSSA Abx
- i.e cover for staph aureus

Question 6

What oral options do we have MSSA (7)

Answer 6

Cloxacillin
Amoxi-clav
Cephalexin/ cefadroxil (1st gen)
Cefuroxime/ cefprozil (2nd gen)
Clindamycin
Macrolides (10%+ resistance)
Fluoroquinolones (10%+ resistance)

Question 7

What oral options we have for MRSA

Answer 7

Sulfatrim
Doxycycline
Linezolid

Question 8

What IV options do we have for MSSA

Answer 8

Cloxacillin
Pip-taz
Cefazolin (1st gen)
Cefuroxime (2nd gen)
Ceftriaxone/ Cefatoxaime (3rd gen)
Carbapenems
Clindamycin
Azithromycin (10%+ resistance)
Fluoroquinolones (10%+ resistance)

Question 9

What IV options do we have for MRSA

Answer 9

• Sulfatrim
• Linezolid
• Vancomycin
• Daptomycin

Question 10

What is the duration of abscess treatment? Evidence

Answer 10

7 days (limited evidence)

Question 11

How long does it take to for drainage and symptoms

Answer 11

72 hours

Question 12

How long does it take for abscess wounds to heal

Answer 12

14 days

Question 13

What symptoms suggesting worsening infection/ failure (4)

Answer 13

Fever
Lymphangitis
Increasing pain
Worsening/ spreading erythema

Question 14

What pathogens are involved in skin abscess?
What if cellulitis is also involved?

Answer 14

Staph aureus (MSSA/MRSA)

If cellulitis: GAS