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{{About|the medical condition|the death metal band|Abscess (band)}}
{{About|the medical condition|the death metal band|Abscess (band)}}

{{Infobox disease
{{Infobox disease
| Name = Abscess
| Name = Abscess
| Image = Abszess.jpg
| Image = File:Blausen 0007 Abscess.png
| Caption = Abscess
| Caption = Abscess
| DiseasesDB =
| DiseasesDB =
Line 15: Line 14:
| MeshID = D000038
| MeshID = D000038
}}
}}
⚫
An '''abscess''' ({{Lang-lat|abscessus}}) is a collection of [[pus]] ([[neutrophils]]) that has accumulated within a tissue because of an inflammatory process in response to either an [[infection|infectious]] process (usually caused by [[bacteria]] or [[parasite]]s) or other foreign materials (e.g., splinters, [[bullet]] [[wound]]s, or [[Injection (medicine)|injecting needles]]). It is a defensive reaction of the [[immune system]] in the tissue to prevent the spread of infectious materials to other parts of the body.


The standard treatment for an uncomplicated skin or soft tissue abscess is opening the skin and draining the fluid. If this is done in a healthy person the wound will heal itself without need for further treatment such as antibiotics.

⚫
==Signs and symptoms==
[[File:Abszess.jpg|thumb|right|an abscess]]
[[File:Ultrasound image of breast 110323101432 1023060.jpg|Ultrasound image of breast abscess, appearing as a mushroom-shaped dark (hypoechoic) area|thumb]]
[[File:Ultrasound image of breast 110323101432 1023060.jpg|Ultrasound image of breast abscess, appearing as a mushroom-shaped dark (hypoechoic) area|thumb]]
⚫
The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules ([[boil]]s) or deep skin abscesses), in the lungs, [[brain abscess|brain]], [[Tooth abscess|teeth]], kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death ([[gangrene]]). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess.
⚫
An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the [[Vertebrate trachea|trachea]] in the context of a deep neck abscess.{{Citation needed|date=July 2008}}

⚫
If superficial, abscesses may be fluctuant when [[palpation|palpated]]. This is a wave-like motion which is caused by movement of the pus inside the abscess.<ref>{{cite book|title=Churchill Livingstone medical dictionary.|year=2008|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780080982458|edition=16th}}</ref>


==Causes==
⚫
An '''abscess''' ({{Lang-lat|abscessus}}) is a collection of [[pus]] ([[neutrophils]]) that has accumulated within a tissue because of an inflammatory process in response to either an [[infection|infectious]] process (usually caused by [[bacteria]] or [[parasite]]s) or other foreign materials (e.g., splinters, [[bullet]] [[wound]]s, or injecting needles). It is a [[immune system|defensive reaction]] of the tissue to prevent the spread of infectious materials to other parts of the body.
An abscess is a [[immune system|defensive reaction]] of the tissue to prevent the spread of infectious materials to other parts of the body.


The organisms or foreign materials kill the local [[cell (biology)|cells]], resulting in the release of [[cytokine]]s. The cytokines trigger an [[inflammation|inflammatory response]], which draws large numbers of [[white blood cell]]s to the area and increases the regional [[blood]] flow.
The organisms or foreign materials kill the local [[cell (biology)|cells]], resulting in the release of [[cytokine]]s. The cytokines trigger an [[inflammation|inflammatory response]], which draws large numbers of [[white blood cell]]s to the area and increases the regional [[blood]] flow.
Line 24: Line 33:
The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.
The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.


==Diagnosis==
Abscesses must be differentiated from [[empyema]]s, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.
Abscesses must be differentiated from [[empyema]]s, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.

⚫
==Signs and symptoms==
⚫
The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules ([[boil]]s) or deep skin abscesses), in the lungs, [[brain abscess|brain]], [[Tooth abscess|teeth]], kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death ([[gangrene]]). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess.
⚫
An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the [[Vertebrate trachea|trachea]] in the context of a deep neck abscess.{{Citation needed|date=July 2008}}

⚫
If superficial, abscesses may be fluctuant when [[palpation|palpated]]. This is a wave-like motion which is caused by movement of the pus inside the abscess.<ref>{{cite book|title=Churchill Livingstone medical dictionary.|year=2008|publisher=Churchill Livingstone|location=Edinburgh|isbn=9780080982458|edition=16th}}</ref>


==Treatment==
==Treatment==
The standard treatment for an uncomplicated skin or soft tissue abscess is opening and draining, and not antibiotics.<ref name="ACEPfive">{{Citation |author1 = American College of Emergency Physicians |author1-link = American College of Emergency Physicians |date = |title = Five Things Physicians and Patients Should Question |publisher = American College of Emergency Physicians |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |page = |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-emergency-physicians/ |accessdate = January 24, 2014}}, which cites
Wound abscesses can be treated with antibiotics. They require surgical intervention, [[debridement]], and [[curettage]].<ref>{{cite book |editor=McLatchie G, Leaper D |title=Oxford Handbook of Clinical Surgery |publisher=OUP |location=Oxford |year=2007 |edition=2nd}}</ref>
*{{cite journal|last=Niska|first=R|coauthors=Bhuiya, F; Xu, J|title=National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary.|journal=National health statistics reports|date=Aug 6, 2010|issue=26|pages=1–31|pmid=20726217}}</ref>


===Incision and drainage===
===Incision and drainage===
Line 43: Line 48:
The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.<ref>{{cite book |title=Surgery: Facts and Figures |last=Green |first=James |author2=Saj Wajed |year=2000 |publisher=Cambridge University Press |isbn= 1-900151-96-0}}</ref>
The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.<ref>{{cite book |title=Surgery: Facts and Figures |last=Green |first=James |author2=Saj Wajed |year=2000 |publisher=Cambridge University Press |isbn= 1-900151-96-0}}</ref>


[[Surgery|Surgical]] drainage of the abscess (e.g., [[Incision and drainage|lancing]]) is usually indicated once the abscess has developed from a harder [[serous]] inflammation to a softer [[pus]] stage. This is expressed in the [[Latin]] medical [[aphorism]]: ''[[Ubi pus, ibi evacua]]''.
[[Surgery|Surgical]] drainage of the abscess (e.g., [[Incision and drainage|lancing]]) is usually indicated once the abscess has developed from a harder [[serous]] inflammation to a softer [[pus]] stage.


In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the [[respiratory tract]]. Warm compresses and elevation of the limb may be beneficial for a skin abscess.
In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the [[respiratory tract]]. Warm compresses and elevation of the limb may be beneficial for a skin abscess.

⚫
=== Antibiotics ===
Persons who have an uncomplicated skin abscess drained in an [[emergency department]] should not take antibiotics nor have a [[cell culture]] grown from their wound if standard followup care can be provided after the incision and drainage.<ref name="ACEPfive"/> Performing a wound culture is unnecessary because it rarely gives information which can be used to guide treatment.<ref name="ACEPfive"/>

Systemic antibiotic treatment in addition to standard incision and drainage is indicated in persons with severe abscesses, multiple sites of infection or other extensive disease, rapid disease progression, symptoms of [[cellulitis]], other symptoms indicating bacterial illness throughout the body, or a health condition causing [[immunosuppression]].<ref name="Singer March 2014">{{cite journal |last=Singer|first=Adam J. |coauthors=Talan, David A. |title=Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus|journal=New England Journal of Medicine|date=13 March 2014|volume=370 |issue=11 |pages=1039–1047 |doi=10.1056/NEJMra1212788}}</ref> People who are very young or very old may also need antibiotics.<ref name="Singer March 2014"/> If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated.<ref name="Singer March 2014"/>

⚫
In those cases of abscess which do require antibiotic treatment, ''[[Staphylococcus aureus]]'' [[bacteria]] is a common cause and an anti-staphylococcus antibiotic such as [[flucloxacillin]] or [[dicloxacillin]] is used. The [[Infectious Diseases Society of America]] advises that the draining of an abscess is not enough to address community-acquired [[Methicillin-resistant Staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'']] (MRSA), and in those cases, traditional antibiotics may be ineffective.<ref name="Singer March 2014"/> Alternative antibiotics effective against community-acquired MRSA often include [[clindamycin]], [[doxycycline]], [[minocycline]], and [[trimethoprim-sulfamethoxazole]].<ref name="Singer March 2014"/> The [[American College of Emergency Physicians]] advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment.<ref name="ACEPfive"/> If the condition is thought to be [[cellulitis]] rather than abscess, consideration should be given to possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin. [[Antibiotic]] therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low [[pH]] levels.


===Packing===
===Packing===
In North America, after drainage, an abscess cavity is often packed, perhaps with cloth, in an attempt to protect the healing wound. However, evidence from emergency medicine literature reports that packing wounds after draining causes pain to the person and does not decrease the rate of recurrence, bring more rapid healing, or lead to fewer physician visits.<ref>{{cite journal|last=Bergstrom|first=KG|title=News, views, and reviews. Less may be more for MRSA: the latest on antibiotics, the utility of packing an abscess, and decolonization strategies.|journal=Journal of drugs in dermatology : JDD|date=2014 Jan|volume=13|issue=1|pages=89-92|pmid=24385125}}</ref>
In North America, after drainage, an abscess cavity is often packed. However, there is no evidence to support this practice and it may in fact delay healing.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=272 |title=BestBets: abscesses; to pack or not to pack }}</ref> To try to answer this question more definitely, a randomized double-blind study was started in September 2008 and was completed in March 2010.<ref>{{ClinicalTrialsGov|NCT00746109|Study of Wound Packing After Superficial Skin Abscess Drainage}}</ref> Interim analysis of data from this study suggests that "wound packing may significantly increase the failure rates." <ref>{{cite web |url=http://aap.confex.com/aap/2009/webprogram/Paper5982.html |title=Randomized Clinical Trial of Packing Following Incision and Drainage of Superficial Skin Abscesses in the Pediatric Emergency Department }}</ref> A small pilot study has found no benefit from packing of simple cutaneous abscesses.<ref>{{cite journal |author=O'Malley GF, Dominici P, Giraldo P, ''et al.'' |title=Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably Unnecessary |journal=Acad Emerg Med |volume= 16|issue= 5|pages= 470–3|date=April 2009 |pmid=19388915 |doi=10.1111/j.1553-2712.2009.00409.x }}</ref>


===Primary closure===
===Primary closure===
Line 54: Line 66:


In anorectal abscesses, primary closure healed faster, but 25% of abscesses [[Wound healing|healed by secondary intention]] and recurrence was higher.<ref name="pmid6397949">{{cite journal |author=Kronborg O, Olsen H |title=Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 4-year follow-up |journal=Acta Chirurgica Scandinavica |volume=150 |issue=8 |pages=689–92 |year=1984 |pmid=6397949 }}</ref>
In anorectal abscesses, primary closure healed faster, but 25% of abscesses [[Wound healing|healed by secondary intention]] and recurrence was higher.<ref name="pmid6397949">{{cite journal |author=Kronborg O, Olsen H |title=Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 4-year follow-up |journal=Acta Chirurgica Scandinavica |volume=150 |issue=8 |pages=689–92 |year=1984 |pmid=6397949 }}</ref>

⚫
=== Antibiotics ===
⚫
As ''[[Staphylococcus aureus]]'' [[bacteria]] is a common cause, an anti-staphylococcus antibiotic such as [[flucloxacillin]] or [[dicloxacillin]] is used. With the emergence of community-acquired methicillin-resistant ''Staphylococcus aureus'' ([[Methicillin-resistant Staphylococcus aureus|MRSA]]), these traditional antibiotics may be ineffective; alternative antibiotics effective against community-acquired MRSA often include [[clindamycin]], [[trimethoprim-sulfamethoxazole]], and [[doxycycline]]. These antibiotics may also be prescribed to patients with a documented allergy to penicillin. (If the condition is thought to be [[cellulitis]] rather than abscess, consideration should be given to possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin). It is important to note that [[antibiotic]] therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low [[pH]] levels. Whilst most medical texts advocate surgical incision some medical doctors will treat small abscesses conservatively with antibiotics.

=== Recurrent infections ===
Recurrent abscesses are often caused by community-acquired [[Methicillin-resistant Staphylococcus aureus|MRSA]]. While resistant to most beta lactam antibiotics commonly used for skin infections, it remains sensitive to alternative antibiotics, e.g., clindamycin (Cleocin), trimethoprim-sulfamethoxazole (Bactrim), and doxycycline (unlike hospital-acquired MRSA that may only be sensitive to vancomycin IV).

To prevent recurrent infections due to ''[[Staphylococcus]]'', consider the following measures:
*Topical [[mupirocin]] applied to the [[nares]].<ref name=Raz1996>{{cite journal | author = Raz R, Miron D, Colodner R, Staler Z, Samara Z, Keness Y | title = A 1-year trial of nasal mupirocin in the prevention of recurrent staphylococcal nasal colonization and skin infection | journal = Arch Intern Med | volume = 156 | issue = 10 | pages = 1109–12 | year = 1996 | pmid = 8638999 | doi = 10.1001/archinte.156.10.1109}}</ref> In this [[randomized controlled trial]], patients used nasal mupirocin twice daily 5 days a month for 1 year.
*[[Chlorhexidine]] baths,<ref name=Watanakunakorn>{{cite journal | author = Watanakunakorn C, Axelson C, Bota B, Stahl C | title = Mupirocin ointment with and without chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents | journal = Am J Infect Control | volume = 23 | issue = 5 | pages = 306–9 | year = 1995 | pmid = 8585642 | doi = 10.1016/0196-6553(95)90061-6}}</ref> In a [[randomized controlled trial]], nasal recolonization with S. aureus occurred at 12 weeks in 24% of nursing home residents receiving mupirocin ointment alone (6/25) and in 15% of residents receiving mupirocin ointment plus chlorhexidine baths daily for the first three days of mupirocin treatment (4/27). Although these results did not reach [[statistical significance]], the baths are an easy treatment.


===Magnesium sulfate paste===
===Magnesium sulfate paste===
Line 71: Line 73:


===Perianal abscess===
===Perianal abscess===
Surgery of the [[anal fistula]] to drain an abscess treats the fistula and reduces likelihood of its recurrence and the need for repeated surgery.<ref name="MalikNelson2010">{{cite journal|last1=Malik|first1=Ali Irqam|last2=Nelson|first2=Richard L|last3=Tou|first3=Samson|last4=Malik|first4=Ali Irqam|title=Incision and drainage of perianal abscess with or without treatment of anal fistula|year=2010|doi=10.1002/14651858.CD006827.pub2}}</ref> There is no evidence that [[fecal incontinence]] is a consequence of this surgery for abscess drainage.<ref name="MalikNelson2010"/>

[[Perianal abscesses]] can be seen in patients with for example [[inflammatory bowel disease]] (such as [[Crohn's disease]]) or [[diabetes]]. Often the abscess will start as an internal wound caused by ulceration, hard stool or penetrative objects with insufficient lubrication. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the [[anus]] which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and [[debridement]] or [[Lancing (surgical procedure)|lancing]].
[[Perianal abscesses]] can be seen in patients with for example [[inflammatory bowel disease]] (such as [[Crohn's disease]]) or [[diabetes]]. Often the abscess will start as an internal wound caused by ulceration, hard stool or penetrative objects with insufficient lubrication. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the [[anus]] which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and [[debridement]] or [[Lancing (surgical procedure)|lancing]].


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}}
}}


==Society==
==Additional images==
The [[Latin]] medical [[aphorism]] "''[[ubi pus, ibi evacua]]''" expresses "where there is pus, there evacuate it" and is classical advice in the culture of Western medicine.
<gallery>

File:Blausen 0007 Abscess.png|Illustration of an Abscess
[[Needle exchange programmes]] often administer or provide referrals for abscess treatment to [[injection drug users]] as part of a [[harm reduction]] public health strategy.<ref>{{cite journal|last=Tomolillo|first=CM|coauthors=Crothers, LJ; Aberson, CL|title=The damage done: a study of injection drug use, injection related abscesses and needle exchange regulation.|journal=Substance use & misuse|date=2007|volume=42|issue=10|pages=1603-11|pmid=17918030}}</ref><ref>{{cite journal|last=Fink|first=DS|coauthors=Lindsay, SP; Slymen, DJ; Kral, AH; Bluthenthal, RN|title=Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities.|journal=Substance use & misuse|date=2013 May|volume=48|issue=7|pages=523-31|pmid=23581506}}</ref>
</gallery>


==See also==
==See also==

Revision as of 18:42, 24 April 2014

This article is about the medical condition. For the death metal band, see Abscess (band).
Abscess
SpecialtyDermatology, general surgery, infectious diseases Edit this on Wikidata

An abscess (Template:Lang-lat) is a collection of pus (neutrophils) that has accumulated within a tissue because of an inflammatory process in response to either an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g., splinters, bullet wounds, or injecting needles). It is a defensive reaction of the immune system in the tissue to prevent the spread of infectious materials to other parts of the body.

The standard treatment for an uncomplicated skin or soft tissue abscess is opening the skin and draining the fluid. If this is done in a healthy person the wound will heal itself without need for further treatment such as antibiotics.

Signs and symptoms

an abscess
Ultrasound image of breast abscess, appearing as a mushroom-shaped dark (hypoechoic) area

The cardinal symptoms and signs of any kind of inflammatory process are redness, heat, swelling, pain and loss of function. Abscesses may occur in any kind of solid tissue but most frequently on skin surface (where they may be superficial pustules (boils) or deep skin abscesses), in the lungs, brain, teeth, kidneys and tonsils. Major complications are spreading of the abscess material to adjacent or remote tissues and extensive regional tissue death (gangrene). Abscesses in most parts of the body rarely heal themselves, so prompt medical attention is indicated at the first suspicion of an abscess. An abscess could potentially be fatal (although this is rare) if it compresses vital structures such as the trachea in the context of a deep neck abscess.[citation needed]

If superficial, abscesses may be fluctuant when palpated. This is a wave-like motion which is caused by movement of the pus inside the abscess.[1]

Causes

An abscess is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body.

The organisms or foreign materials kill the local cells, resulting in the release of cytokines. The cytokines trigger an inflammatory response, which draws large numbers of white blood cells to the area and increases the regional blood flow.

The final structure of the abscess is an abscess wall, or capsule, that is formed by the adjacent healthy cells in an attempt to keep the pus from infecting neighboring structures. However, such encapsulation tends to prevent immune cells from attacking bacteria in the pus, or from reaching the causative organism or foreign object.

Diagnosis

Abscesses must be differentiated from empyemas, which are accumulations of pus in a preexisting rather than a newly formed anatomical cavity.

Treatment

The standard treatment for an uncomplicated skin or soft tissue abscess is opening and draining, and not antibiotics.[2]

Incision and drainage

Main article: Incision and drainage
Five day old Abscess. Notice the black dot pertaining to the infection on hair follicle.
Abscess five days after incision and drainage.
Abscess following curettage.

The abscess should be inspected to identify if foreign objects are a cause, which may require their removal. If foreign objects are not the cause, a doctor will incise and drain the abscess and prescribe painkillers and possibly antibiotics.[3]

Surgical drainage of the abscess (e.g., lancing) is usually indicated once the abscess has developed from a harder serous inflammation to a softer pus stage.

In critical areas where surgery presents a high risk, it may be delayed or used as a last resort. The drainage of a lung abscess may be performed by positioning the patient in a way that enables the contents to be discharged via the respiratory tract. Warm compresses and elevation of the limb may be beneficial for a skin abscess.

Antibiotics

Persons who have an uncomplicated skin abscess drained in an emergency department should not take antibiotics nor have a cell culture grown from their wound if standard followup care can be provided after the incision and drainage.[2] Performing a wound culture is unnecessary because it rarely gives information which can be used to guide treatment.[2]

Systemic antibiotic treatment in addition to standard incision and drainage is indicated in persons with severe abscesses, multiple sites of infection or other extensive disease, rapid disease progression, symptoms of cellulitis, other symptoms indicating bacterial illness throughout the body, or a health condition causing immunosuppression.[4] People who are very young or very old may also need antibiotics.[4] If the abscess does not heal only with incision and drainage, or if the abscess is in a place that is difficult to drain such as the face, hands, or genitals, then antibiotics may be indicated.[4]

In those cases of abscess which do require antibiotic treatment, Staphylococcus aureus bacteria is a common cause and an anti-staphylococcus antibiotic such as flucloxacillin or dicloxacillin is used. The Infectious Diseases Society of America advises that the draining of an abscess is not enough to address community-acquired Methicillin-resistant Staphylococcus aureus (MRSA), and in those cases, traditional antibiotics may be ineffective.[4] Alternative antibiotics effective against community-acquired MRSA often include clindamycin, doxycycline, minocycline, and trimethoprim-sulfamethoxazole.[4] The American College of Emergency Physicians advises that typical cases of abscess from MRSA get no benefit from having antibiotic treatment in addition to the standard treatment.[2] If the condition is thought to be cellulitis rather than abscess, consideration should be given to possibility of strep species as cause that are still sensitive to traditional anti-staphylococcus agents such as dicloxacillin or cephalexin in patients able to tolerate penicillin. Antibiotic therapy alone without surgical drainage of the abscess is seldom effective due to antibiotics often being unable to get into the abscess and their ineffectiveness at low pH levels.

Packing

In North America, after drainage, an abscess cavity is often packed, perhaps with cloth, in an attempt to protect the healing wound. However, evidence from emergency medicine literature reports that packing wounds after draining causes pain to the person and does not decrease the rate of recurrence, bring more rapid healing, or lead to fewer physician visits.[5]

Primary closure

Primary closure has been successful when combined with curettage and antibiotics[6] or with curettage alone.[7] However, another randomized controlled trial found primary closure led to 35% failing to heal primarily and primary closure longer median number of days to closure (8.9 versus 7.8).[8]

In anorectal abscesses, primary closure healed faster, but 25% of abscesses healed by secondary intention and recurrence was higher.[9]

Magnesium sulfate paste

Historically abscesses as well as boils and many other collections of pus have been treated via application of magnesium sulfate (Epsom salt) paste. This works by drawing the infected pus to the surface of the skin before rupturing and leaking out. After this the body will usually repair the old infected cavity. Magnesium sulfate is therefore best applied at night with a sterile dressing covering it, as the rupture itself is not painful but the drawing up may be uncomfortable.

Location

Perianal abscess

Surgery of the anal fistula to drain an abscess treats the fistula and reduces likelihood of its recurrence and the need for repeated surgery.[10] There is no evidence that fecal incontinence is a consequence of this surgery for abscess drainage.[10]

Perianal abscesses can be seen in patients with for example inflammatory bowel disease (such as Crohn's disease) or diabetes. Often the abscess will start as an internal wound caused by ulceration, hard stool or penetrative objects with insufficient lubrication. This wound typically becomes infected as a result of the normal presence of feces in the rectal area, and then develops into an abscess. This often presents itself as a lump of tissue near the anus which grows larger and more painful with time. Like other abscesses, perianal abscesses may require prompt medical treatment, such as an incision and debridement or lancing.

Other types of abscess

The following types of abscess are listed in the medical dictionary:[11]

3

Society

The Latin medical aphorism "ubi pus, ibi evacua" expresses "where there is pus, there evacuate it" and is classical advice in the culture of Western medicine.

Needle exchange programmes often administer or provide referrals for abscess treatment to injection drug users as part of a harm reduction public health strategy.[12][13]

See also

References

  1. ^ Churchill Livingstone medical dictionary (16th ed.). Edinburgh: Churchill Livingstone. 2008. ISBN 9780080982458.
  2. ^ a b c d American College of Emergency Physicians, "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Emergency Physicians, retrieved January 24, 2014, which cites
    • Niska, R (Aug 6, 2010). "National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary". National health statistics reports (26): 1–31. PMID 20726217. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  3. ^ Green, James; Saj Wajed (2000). Surgery: Facts and Figures. Cambridge University Press. ISBN 1-900151-96-0.
  4. ^ a b c d e Singer, Adam J. (13 March 2014). "Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus". New England Journal of Medicine. 370 (11): 1039–1047. doi:10.1056/NEJMra1212788. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Bergstrom, KG (2014 Jan). "News, views, and reviews. Less may be more for MRSA: the latest on antibiotics, the utility of packing an abscess, and decolonization strategies". Journal of drugs in dermatology : JDD. 13 (1): 89–92. PMID 24385125. {{cite journal}}: Check date values in: |date= (help)
  6. ^ Abraham N, Doudle M, Carson P (1997). "Open versus closed surgical treatment of abscesses: a controlled clinical trial". The Australian and New Zealand journal of surgery. 67 (4): 173–6. doi:10.1111/j.1445-2197.1997.tb01934.x. PMID 9137156.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ Stewart MP, Laing MR, Krukowski ZH (1985). "Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial". The British journal of surgery. 72 (1): 66–7. doi:10.1002/bjs.1800720125. PMID 3881155.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Simms MH, Curran F, Johnson RA; et al. (1982). "Treatment of acute abscesses in the casualty department". British medical journal (Clinical research ed.). 284 (6332): 1827–9. doi:10.1136/bmj.284.6332.1827. PMC 1498721. PMID 6805714. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  9. ^ Kronborg O, Olsen H (1984). "Incision and drainage v. incision, curettage and suture under antibiotic cover in anorectal abscess. A randomized study with 4-year follow-up". Acta Chirurgica Scandinavica. 150 (8): 689–92. PMID 6397949.
  10. ^ a b Malik, Ali Irqam; Nelson, Richard L; Tou, Samson; Malik, Ali Irqam (2010). "Incision and drainage of perianal abscess with or without treatment of anal fistula". doi:10.1002/14651858.CD006827.pub2. {{cite journal}}: Cite journal requires |journal= (help)
  11. ^ "Abscess". Medical Dictionary - Dictionary of Medicine and Human Biology. Retrieved 2013-01-24.
  12. ^ Tomolillo, CM (2007). "The damage done: a study of injection drug use, injection related abscesses and needle exchange regulation". Substance use & misuse. 42 (10): 1603–11. PMID 17918030. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ Fink, DS (2013 May). "Abscess and self-treatment among injection drug users at four California syringe exchanges and their surrounding communities". Substance use & misuse. 48 (7): 523–31. PMID 23581506. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
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