3
Purulent SSTIs (cutaneous abscesses, furuncles, carbuncles, and
inflamed epidermoid cysts) (Figure 1)
Î Gram stain and culture of pus from carbuncles and abscesses are
recommended, but treatment without these studies is reasonable in
typical cases (SR-M).
Î Gram stain and culture of pus from inflamed epidermoid cysts are NOT
recommended (SR-M).
Î Incision and drainage is the recommended treatment for inflamed
epidermoid cysts, carbuncles, abscesses and large furuncles
(See Fig. 1/Purulent/MILD) (SR-H).
Î The decision to administer antibiotics directed against S. aureus as an
adjunct to incision and drainage should be made based on the presence
or absence of systemic inflammatory response syndrome (SIRS) such as
temperature >38°C or <36°C, tachypnea >24 breaths/min, tachycardia
>90 beats/min or white blood cell count (WBC) >12,000 or <400
cells/mm
3
(See Fig. 1/Purulent/MODERATE) (SR-L). An antibiotic
active against MRSA is recommended for patients with carbuncles or
abscesses who have failed initial antibiotic treatment, have markedly
impaired host defenses, or in patients with SIRS and hypotension (See
Fig. 1/Purulent/SEVERE and Table 1) (SR-L). Tedizolid and dalbavancin
are also effective treatments of SSTI including those caused by MRSA
and were approved by the FDA after publication of the 2014 guideline.
Recurrent Skin Abscesses
Î A recurrent abscess at a site of previous infection should prompt
a search for local causes such as a pilonidal cyst, hidradenitis
suppurativa or foreign material (SR-M).
Î Recurrent abscesses should be drained and cultured early in the
course of infection (SR-M).
Î After obtaining cultures of recurrent abscess, treat with a 5- to 10-day
course of an antibiotic active against the pathogen isolated (WR-L).
Î Consider a 5-day decolonization regimen of intranasal mupirocin bid,
daily chlorhexidine washes, and daily decontamination of personal
items such as towels, sheets, and clothes for recurrent S. aureus
infection (WR-L).
Î Adult patients should be evaluated for neutrophil disorders if recurrent
abscesses began in early childhood (SR-M).
