Management of Multiple Abscesses and Carbuncles in Infants

Initial Management

Incision and drainage is the cornerstone of treatment for abscesses and carbuncles in infants, with thorough evacuation of pus and probing of the cavity to break up loculations 1, 2, 3
After drainage, simply covering the surgical site with a dry sterile dressing is usually the most effective wound management; packing may cause unnecessary pain and does not improve healing 3, 4
Gram stain and culture of pus from carbuncles and abscesses should be obtained, especially in infants with multiple lesions, though empiric treatment can begin before results are available 1, 2

Systemic antibiotics should be added to incision and drainage when the infant shows signs of systemic inflammatory response syndrome (SIRS): temperature >38°C or <36°C, tachypnea >24 breaths per minute, tachycardia >90 beats per minute, or abnormal white blood cell count 1, 2
Systemic antibiotics are indicated when multiple lesions are present, extensive surrounding cellulitis is present, or the infant has impaired host defenses 1, 2, 5, 6
For empiric therapy, choose an antibiotic active against Staphylococcus aureus, the most common pathogen in abscesses and carbuncles 1, 2
First-generation cephalosporins can be used if MSSA is suspected 7
Clindamycin or trimethoprim-sulfamethoxazole can be used for infants with MRSA risk factors or in areas with high MRSA prevalence 7
Adjust therapy based on culture and susceptibility results when available 1, 2

Early drainage and culture of recurrent lesions, followed by a 5-10 day course of antibiotics active against the isolated pathogen 1, 2
Consider decolonization measures including chlorhexidine baths, mupirocin intranasal application, and decontamination of personal items 1, 2, 6
Evaluate for underlying conditions that may predispose to recurrent infections, particularly neutrophil disorders, as recurrent abscesses in early childhood may indicate an underlying immune deficiency 1, 2

Infants are considered hosts with potentially impaired defenses, warranting a lower threshold for systemic antibiotic therapy 1, 2

Close follow-up is essential to ensure resolution of infection and to identify any new lesions
If lesions are not improving with initial therapy, consider inadequate drainage 7, resistant organisms 4, or underlying conditions predisposing to infection 1, 2
Consider evaluation for neutrophil disorders if abscesses began in early infancy or are recurrent 1, 2