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Skin abscess

Key sources
The following summarized guidelines for the evaluation and management of skin abscess are prepared by our editorial team based on guidelines from the British Medical Journal (BMJ 2018), the Surgical Infection Society Europe (SIS-E/WSES 2018), the Korean Society of Infectious Diseases (KSID/KDA/KOA/KSC 2017), and the Infectious Diseases Society of America (IDSA 2014; 2011).
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Guidelines

1.Diagnostic investigations

Gram stain and culture: as per KSID 2017 guidelines, obtainGram staining and bacterial culture testing on pus samples from purulent SSTI, although consider initiating treatment without testing in typical cases.
B
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2.Medical management

Antibiotic therapy, initial empiric therapy, BMJ
Consider administering TMP/SMX or clindamycin along with incision and drainage rather than incision and drainage alone in patients with an uncomplicated skin abscess. Discuss both options with each patient.
C
Administer TMP/SMX or clindamycin over cephalosporins.
A
Consider administering TMP/SMX over clindamycin. Discuss options with patients in shared decision-making.
B

More topics in this section

  • Antibiotic therapy (MRSA coverage)

3.Surgical interventions

Incision and drainage: as per WSES 2018 guidelines, perform incision and drainage for the treatment of simple abscesses or furuncles.
B

4.Specific circumstances

Patients with complex abscesses
Perform incision and drainage in patients with complex skin and subcutaneous abscesses (perianal and perirectal, and abscesses in intravenous drug injection sites).
B
Administer empiric broad-spectrum antibiotics (with coverage of Gram-positive, Gram-negative, and anaerobic bacteria) in the presence of systemic signs of infection, in immunocompromised patients, if source control is incomplete, or in cases of abscess with significant cellulitis.
B

5.Follow-up and surveillance

Serial microbiological testing: obtain cultures from abscesses in patients treated with antibiotic therapy, not responding adequately to initial treatment, and if there is a concern for a cluster or outbreak.
B

More topics in this section

  • Management of recurrent abscesses (evaluation)

  • Management of recurrent abscesses (drainage and antibiotic therapy)

  • Management of recurrent abscesses (decolonization strategies)