What are the guideline sources, guidelines and references for Skin abscess ?
Guideline sources The following summarized guidelines for the evaluation and management of skin abscess are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2014). 1 Guidelines 1. Diagnostic investigations Gram stain and culture: Obtain Gram stain and culture of pus from carbuncles and abscesses, but consider initiating treatment without these studies in patients with a typical presentation. B Avoid routinely obtaining Gram stain and culture of pus from inflamed epidermoid cysts. D Evaluation for recurrent abscess: Evaluate patients with recurrent skin abscesses at a site of previous skin infection for local causes such as a pilonidal cyst, hidradenitis suppurativa, or foreign material. B Evaluate patients with recurrent abscesses beginning in early childhood for neutrophil disorders. B 2. Medical management Antibiotic therapy (first episode): https://web.pathway.md/diseases/recYw57aNp5B5VlxG 1/3 6/24/23, 3:12 PM Skin abscess Pathway py ( p ) Administer antibiotics directed against S. aureus as an adjunct to incision and drainage in patients with systemic signs of infection, such as: temperature > 38 C or < 36 C respiratory rate > 24 breaths per minute hear rate > 90 bpm WBC count > 12 000 or < 400 cells/ L. B Administer an antibiotic active against MRSA for patients with carbuncles or abscesses who have failed initial antibiotic treatment, have markedly impaired host defenses, or have a systemic inflammatory response syndrome associated with hypotension. B Updated evidence: Antibiotics for small skin abscesses In patients with a simple abscess ( 5 cm in diameter), clindamycin or TMP-sulfamethoxazole (TMP-SMX) in conjunction with incision and drainage, as compared with incision and drainage alone, increases the cure rate (68.9%, p < 0.001 for both comparisons). This beneficial effect was restricted to participants with S. aureus infection. The cure rate among participants in the clindamycin group was similar to that in the TMP-SMX group (83.1% and 81.7%, p = 0.73). The incidence of new infections in participants initially cured at 1 month follow-up was less common in the clindamycin group (6.8%, p = 0.03) than in the TMP-SMX group (13.5%, p = 0.03) or the placebo group (12.4%, p = 0.06). Adverse events were more frequent with clindamycin (21.9%) than with TMP-SMX (11.1%) or placebo (12.5%); all adverse events resolved without sequelae. One participant who received TMP-SMX had a hypersensitivity reaction. Daum RS et al. N Engl J Med. 2017 Jun 29. Antibiotic therapy (recurrent abscess): administer a 5- to 10-day course of an antibiotic active against the infecting pathogen after obtaining cultures for a recurrent skin abscess. B Decolonization therapy: consider a 5-day decolonization regimen for recurrent S. aureus infection, consisting of intranasal mupirocin BID, chlorhexidine washes daily, and daily decontamination of personal items such as towels, sheets, and clothes. C 3. Therapeutic procedures Incision and drainage: Perform incision and drainage for inflamed epidermoid cysts, carbuncles, abscesses, and large furuncles. A Drain and culture recurrent abscesses early in the course of infection. B References https://web.pathway.md/diseases/recYw57aNp5B5VlxG 2/3 6/24/23, 3:12 PM Skin abscess Pathway 1. Stevens DL, Bisno AL, Chambers HF et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59 2):e10 52. Open 2. David A Talan, William R Mower, Anusha Krishnadasan et al. Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. N Engl J Med. 2016 Mar 3;374 9 823 32. Open 3. Yee Gyung Kwak, Seong Ho Choi, Tark Kim et al. Clinical Guidelines for the Antibiotic Treatment for Community-Acquired Skin and Soft Tissue Infection. Infect Chemother. 2017 Dec;49 4 301 325. Open https://web.pathway.md/diseases/recYw57aNp5B5VlxG 3/3