{"id":3420,"date":"2014-06-16T13:00:00","date_gmt":"2014-06-16T13:00:00","guid":{"rendered":"http:\/\/www.emlitofnote.com\/?p=3420"},"modified":"2014-06-16T13:00:00","modified_gmt":"2014-06-16T13:00:00","slug":"abscess-management-in-the-era-of-mrsa","status":"publish","type":"post","link":"https:\/\/www.emlitofnote.com\/?p=3420","title":{"rendered":"Abscess Management in the Era of MRSA"},"content":{"rendered":"<p>Every so often, it\u2019s good to circle back from the esoteric to the basics, and remind ourselves how to provide the best, evidence-based treatment for some of the most common diseases \u2013 in this case, abscesses.<\/p>\n<p>This review in the New England Journal is a reasonable, concise overview of the evidence behind management of cutaneous abscesses, updated for the increasing prevalence of methicillin-resistant Staphylococcus aureus. &nbsp;And, quite simply, there\u2019s no evidence for any reason yet to panic. &nbsp;The authors of this article summarize the literature thusly:<\/p>\n<ul>\n<li>Incision &amp; drainage is definitive treatment. &nbsp;Non-complicated disease does not require additional antibiotic treatment, and the incremental benefit \u2013 if any \u2013 would be single-digit differences in clinical failure.<\/li>\n<li>Packing of abscesses is a matter of tradition, and evidence is neither sufficient to conclusively confirm nor refute this practice.<\/li>\n<li>Primary closure of abscesses after I&amp;D is reasonable, particularly for larger, exposed, and cosmetically important areas.<\/li>\n<li>Antibiotic coverage for primarily cellulitic soft-tissue infections ideally includes both MRSA and streptococcal coverage, but recent evidence showed no advantage to double-coverage. &nbsp;Clinical trials regarding antibiotic use are ongoing: &nbsp;<a href=\"http:\/\/clinicaltrials.gov\/show\/NCT00729937\">NCT00729937<\/a> <a href=\"http:\/\/clinicaltrials.gov\/show\/NCT00730028\">NCT00730028<\/a> &nbsp;<a href=\"http:\/\/clinicaltrials.gov\/show\/NCT00729937\">NCT00729937<\/a><\/li>\n<li>Wound cultures are not necessary.<\/li>\n<\/ul>\n<p>One could argue covering such basics in infection and wound management is a sundry affair for a blog frequently covering the cutting edge. &nbsp;However, current management of such a common condition is so highly variable and frequently low-value, ACEP even made a point to include abscess management in their <a href=\"http:\/\/www.acep.org\/Clinical---Practice-Management\/ACEP-Announces-List-of-Tests-As-Part-of-Choosing-Wisely-Campaign\/\">Choosing Wisely campaign list<\/a>.<\/p>\n<p>Now, go and do as little harm as possible.<\/p>\n<p>&#8220;Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus&#8221;<br \/><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24620867\">http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24620867<\/a><\/p>\n<div><\/div>\n\n<div class=\"twitter-share\"><a href=\"https:\/\/twitter.com\/intent\/tweet?via=emlitofnote\" class=\"twitter-share-button\">Tweet<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Every so often, it\u2019s good to circle back from the esoteric to the basics, and remind ourselves how to provide the best, evidence-based treatment for some of the most common diseases \u2013 in this case, abscesses. This review in the New England Journal is a reasonable, concise overview of the evidence behind management of cutaneous &hellip; <a href=\"https:\/\/www.emlitofnote.com\/?p=3420\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Abscess Management in the Era of MRSA&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[10,9,11],"tags":[],"class_list":["post-3420","post","type-post","status-publish","format-standard","hentry","category-antibiotics","category-infectious-disease","category-quality"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p7KesJ-Ta","jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3420","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3420"}],"version-history":[{"count":0,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=\/wp\/v2\/posts\/3420\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3420"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3420"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.emlitofnote.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3420"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}