Management of Abscesses
Definition and Characteristics
- Simple abscesses are defined by induration and erythema limited to the abscess area, no extension into deeper tissues, and absence of significant surrounding cellulitis, with no systemic signs of infection 1, 2, 3, 4, 7
- Complicated abscesses are characterized by factors such as perianal and perirectal locations, presence of significant surrounding cellulitis, multiloculation, deep tissue extension, and large size (>5 cm) 1, 2, 4, 5, 8, 9
Treatment Approach
- The primary treatment for simple abscesses is incision and drainage, with antibiotics not typically needed in immunocompetent patients 3, 4, 5, 6, 7
- Complicated abscesses require both surgical drainage and broad-spectrum antibiotic therapy covering Gram-positive, Gram-negative, and anaerobic organisms 1, 2, 4
Antibiotic Selection
- Empiric broad-spectrum coverage must include Gram-positive, Gram-negative, and anaerobic bacteria for complicated abscesses 1, 2, 4
- Consideration of MRSA coverage with glycopeptides is necessary if suspected 3, 4
Surgical Approach
- Perianal and perirectal abscesses require prompt surgical drainage to prevent expansion and systemic infection, with incisions made close to the anal verge to minimize potential fistula length 1, 2, 5, 8
- IV drug user abscesses require special considerations due to their polymicrobial nature and potential for foreign bodies and vascular complications 1, 3
Timing and Setting Considerations
- Simple abscesses can be managed in ambulatory settings with local anesthesia and same-day discharge 8
- Complicated abscesses require emergent drainage in cases of sepsis, severe sepsis, or septic shock, and may necessitate general anesthesia and inpatient management 5, 8