Materiały źródłowe

• #1 Skin abscess – WikEM

  https://wikem.org/wiki/Skin_abscess

  Localized collection of pus surrounded by inflamed tissue, usually caused by bacterial infection. […] MRSA is the most common cause of purulent skin and soft-tissue infections. […] Standard skin abscess are not typically due to spider bites and should not be diagnosed as such. […] Skin abscess typically a clinical diagnosis, with or without use of bedside soft tissue ultrasound and/or ID for confirmation.

• #1 Cutaneous Abscess – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/cutaneous-abscess

  Diagnosis of cutaneous abscess is usually by clinical examination. Culture is recommended, primarily to identify MRSA. […] Conditions resembling simple cutaneous abscesses include hidradenitis suppurativa and ruptured epidermal cysts. […] Culture of these ruptured cysts seldom reveals any pathogens. […] Pathogens reflect flora of the involved area (eg, S. aureus and streptococci in the trunk, axilla, head, and neck). […] Culture abscesses to identify MRSA.

• #1 Skin Abscess: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/skin-abscess

  Once you’ve made an appointment with your doctor, they will review your medical history and perform a physical examination to visually inspect the abscess. […] A complete physical examination is the best way for your doctor to tell if an injury or ingrown hair is the cause of the abscess. […] Your doctor may take a culture or a small amount of fluid or pus from the abscess to test for the presence of bacteria. No other testing methods are necessary to diagnose an abscess. […] However, your doctor may decide to do a blood test to rule out the possibility of sepsis. […] Even if you’re not certain you have an abscess, it’s important to bring it up with your doctor, as an untreated abscess can lead to serious complications and can become life threatening.

• #1

  https://www2.hse.ie/conditions/abscess/diagnosis/

  Talk to your GP if you think you have an abscess. […] There are a few tests used to diagnose an abscess. The type of test you get depends on where it is on your body. […] If you have a skin abscess, a GP will examine the affected area and may ask you: […] Some pus may be taken from your abscess and sent for testing. This will identify the type of bacteria causing the abscess. This helps to find the best way of treating it. […] If you’ve had more than 1 skin abscess, you may need to give a sample of your pee. This will be tested for glucose, which is a sign of diabetes. People with diabetes have an increased risk of developing skin abscesses. […] If you have recurring boils and abscesses, your GP may get the laboratory to do more tests on the bacteria. These extra tests will show if it’s producing Panton-Valentine leukocidin (PVL) toxin.

• #1 Cutaneous abscess

  https://dermnetnz.org/topics/cutaneous-abscess

  What tests should be done? […] If the cause of an abscess is unknown, the following tests may be undertaken. […] Microscopy and Gram stain […] Bacterial culture (standard, anaerobic, and at low temperature) […] Biopsy of adjacent tissue. […] If a patient has had recurrent abscesses, consider nutritional deficiency, especially of iron; immune deficiency; immune suppression by medications such as systemic steroids; diabetes; or poor circulation. […] What is the treatment of an abscess? […] An abscess should be explored to remove foreign bodies, and its contents should be removed. […] This requires making a surgical incision and draining the pus. […] The cavity is then thoroughly washed out with saline. […] It should be left open to allow further pus to drain away. […] Wicks are sometimes inserted if the abscess is deep, to help it drain. […] Antibiotics are often prescribed, chosen according to the organism causing the abscess and its sensitivities.

• #1 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Skin and soft tissue infections result from microbial invasion of the skin and its supporting structures. […] The diagnosis is based on clinical evaluation. Laboratory testing may be required to confirm an uncertain diagnosis, evaluate for deep infections or sepsis, determine the need for inpatient care, and evaluate and treat comorbidities. […] The diagnosis of SSTIs is predominantly clinical. A complete blood count, C-reactive protein level, and liver and kidney function tests should be ordered for patients with severe infections, and for those with comorbidities causing organ dysfunction. […] Blood cultures are unlikely to change the management of simple localized SSTIs in otherwise healthy, immunocompetent patients, and are typically unnecessary. […] However, because of the potential for deep tissue involvement, cultures are useful in patients with severe infections or signs of systemic involvement, in older or immunocompromised patients, and in patients requiring surgery.

• #1 Skin and Soft Tissue Infections | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0915/p474.html

  Tissue biopsies, which are the preferred diagnostic test for necrotizing SSTIs, are ideally taken from the advancing margin of the wound, from the depth of bite wounds, and after debridement of necrotizing infections and traumatic wounds. […] Imaging studies are not indicated for simple SSTIs, and surgery should not be delayed for imaging. […] The Laboratory Risk Indicator for Necrotizing Fasciitis score uses laboratory parameters to stratify patients into high- and low-risk categories for necrotizing fasciitis; a score of 6 or higher is indicative, whereas a score of 8 or higher is strongly predictive (positive predictive value = 93.4%).

• #1 Abscesses – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/biology-of-infectious-disease/abscesses

  Diagnosis of cutaneous and subcutaneous abscesses is by physical examination. […] Diagnosis of deep abscesses often requires imaging. Ultrasound is noninvasive and detects many soft-tissue abscesses; CT is accurate for most, although MRI is usually more sensitive. […] Cutaneous and subcutaneous abscesses are diagnosed clinically; deeper abscesses often require imaging.

• #1 Point-of-Care Ultrasonography for the Diagnosis of Skin and Soft Tissue Abscesses: A Systematic Review and Meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32081383/

  Study objective: Skin and soft tissue infections are a common chief complaint in the emergency department. Research has shown that clinical examination alone can be unreliable in distinguishing between cellulitis and abscesses, a distinction that is important because they each require different treatments. Point-of-care ultrasonography has been increasingly studied as a tool to improve the diagnostic accuracy for these skin and soft tissue infections. The primary objective of this systematic review is to evaluate the diagnostic accuracy of point-of-care ultrasonography for abscesses. […] According to the current data, point-of-care ultrasonography has good diagnostic accuracy for differentiating abscesses from cellulitis and led to a correct change in management in 10% of cases.

• #1 Point-of-care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27770490/

  Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). […] The objective was to describe the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in ED patients with SSTI. […] The POCUS HSROC revealed a sensitivity of 97% (95% CI = 94% to 98%), specificity of 83% (95% CI = 75% to 88%), LR+ of 5.5 (95% CI = 3.7 to 8.2), and LR- of 0.04 (95% CI = 0.02 to 0.08). […] Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.

• #1 Abscess Evaluation | Sonoguide

  https://www.acep.org/sonoguide/procedures/abscess-evaluation

  Many researchers, including emergency physicians, have reported on the utility of ultrasound in the evaluation of abscesses and cellulitis. […] One group of emergency physicians found that soft-tissue ultrasound changed the management strategy for approximately half of their patients and concluded that ultrasound was useful because it could detect occult abscesses and avoid invasive procedures. […] The use of point-of-care ultrasound has been associated with a decreased length of stay for children with soft tissue infection. […] Ultrasound also allows many procedures to be done with greater safety. In the case of abscess drainage, ultrasound can locate adjacent structures such as large blood vessels and nerves that need to be avoided during the drainage procedure. […] The use of bedside ultrasound can also help determine the treatment of a specific abscess based on its size and depth. If an abscess is very small (1 cm diameter), the physician might choose treatment with antibiotics and warm compresses rather than incision and drainage.

• #1 Abscess Evaluation | Sonoguide

  https://www.acep.org/sonoguide/procedures/abscess-evaluation

  Although the majority of abscesses are treated with incision and drainage, in certain cases, usually because of cosmesis, treatment with needle aspiration and antibiotics may be an option. […] Ultrasound provides dynamic real-time guidance for needle aspiration, increasing the likelihood of success. […] On ultrasound, an abscess is a spherical or oblong structure that is largely anechoic or hypoechoic. […] However, as opposed to a simple cyst that will be uniformly anechoic throughout, an abscess will contain hyperechoic debris. This feature can be used to differentiate an abscess from a cyst. […] Dynamic scanning, achieved with gentle compression of the probe, might cause the contents of the abscess to swirl, which can be diagnostic of an abscess. […] Ultrasound is effective at identifying occult abscesses in emergency department patients initially suspected of having cellulitis. […] On ultrasound imaging, an abscess appears as a spherical or oblong anechoic or hypoechoic collection containing hyperechoic debris.

• #1 Accuracy of Point-of-Care Ultrasound for Diagnosing Soft Tissue Abscess – TheNNT

  https://www.thennt.com/cms/lr/accuracy-point-care-ultrasound-diagnosing-soft-tissue-abscess/

  Accuracy of Point-of-Care Ultrasound for Diagnosing Soft Tissue Abscess. The systematic review summarized here included prospective cohort studies evaluating POCUS for diagnosis of abscess in ED patients. The primary outcome was diagnostic accuracy for abscess in the ED. Calculation of the point estimates for the diagnostic accuracy of POCUS found a sensitivity of 95.5% (95% confidence interval [CI] 88.9-98.3) and specificity of 80.3% (95% CI 56.4-92.7). […] The largest study included in the analysis, comprising 25% of the reviews sample size, found that POCUS did not add to the diagnostic post-test probability (and may have lowered both sensitivity and specificity) when clinicians felt confident of the diagnosis before ultrasound (i.e. when pre-test probability was high). However, when the pre-test probability was low or moderate, ultrasound was found to be helpful in increasing the post-test probability.

• #1 Bacterial Skin Abscess | IntechOpen

  https://www.intechopen.com/chapters/71743

  Patients with skin and soft tissue infections may appear with the abscess. […] The diagnosis is based on skin abscess usually on the clinical manifestations. […] The most common microbiologic cause of skin abscess is S. aureus; a skin abscess can be caused by more than one pathogen. […] It can be a useful radiographic examination to determine whether the skin abscess is present (via ultrasound) to distinguish cellulitis from osteomyelitis (via magnetic resonance imaging). […] The diagnosis of skin abscess usually depends on the clinical manifestations. Abscess appears Oristepelas in areas of skin erythema, edema, and warmth. […] For laboratory tests are not required for patients with uncomplicated infection in the absence of associated diseases or complications. […] Routine culture of materials debrided is not necessary in healthy patients who are not receiving antibiotics.

• #1 Abscess – Wikipedia

  https://en.wikipedia.org/wiki/Abscess

  An abscess is a localized collection of pus (purulent inflammatory tissue) caused by suppuration buried in a tissue, an organ, or a confined space, lined by the pyogenic membrane. Ultrasound imaging can help in a diagnosis. […] Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open. Ultrasound imaging may be useful in cases in which the diagnosis is not clear. In abscesses around the anus, computer tomography (CT) may be important to look for deeper infection. […] Abscesses should be differentiated from empyemas, which are accumulations of pus in a preexisting, rather than a newly formed, anatomical cavity. Other conditions that can cause similar symptoms include: cellulitis, a sebaceous cyst, and necrotising fasciitis. Cellulitis typically also has an erythematous reaction, but does not confer any purulent drainage.

• #1 Abscess Evaluation | Sonoguide

  https://www.acep.org/sonoguide/procedures/abscess-evaluation

  Abscess and cellulitis are two of the most common soft-tissue infections seen in patients treated in emergency departments. Although they sometimes occur together, they are different disease processes requiring different treatments. […] It can be difficult to differentiate cellulitis from abscess based only on history and physical examination findings. Both processes can generally be characterized by warmth, erythema, tenderness, swelling, and induration. […] Because of the difficulty in diagnosis, the emergency physician might decide on an inappropriate treatment, resulting in one of two possible errors. Incision and drainage might not be done in a patient with an abscess, or incision and drainage could be performed on a patient who has cellulitis but no abscess. Increased pain and poor patient outcome can result from either of these errors.

• #1 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based upon presence or absence of systemic inflammatory response syndrome (SIRS). […] 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. […] Recurrent abscesses should be drained and cultured early in the course of infection. […] After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated. […] Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood. […] Cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended.

• #1 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  Cultures of blood are recommended, and cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites. […] The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period. […] Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient, or if outpatient treatment is failing. […] The most important therapy for an SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention.

• #1 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Patients with skin and soft tissue infections may present with cellulitis, skin abscess, and other syndromes of infection. […] Clinical manifestations and diagnosis of skin abscesses, furuncles, and carbuncles are discussed separately. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] During the incision and drainage procedure, we recommend that samples of pus be obtained and sent for Gram stain and culture. […] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. […] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #1 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Several trials have indicated a benefit to antibiotic therapy, even in patients with small abscesses. […] The choice of antibiotic is typically dependent on the suspected microorganisms, severity of illness, and patient allergies and comorbidities. […] Patients with skin abscess should receive empiric therapy that covers S. aureus, including MRSA. […] The decision to initiate parenteral therapy is typically based on the extent and severity of infection and patient comorbidities. […] For individuals with skin abscess, we suggest initial treatment with parenteral antibiotics in the following circumstances: Systemic signs of toxicity, Rapid progression of erythema or abscess, Extensive abscess or surrounding erythema, Immunocompromising condition, Inability to tolerate or absorb oral therapy.

• #1 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  The duration of therapy should be individualized based on clinical response. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in approximately 10 percent of patients. […] Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission.

• #1 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  The duration of therapy should be individualized based on clinical response. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse. […] Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #2 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Patients with skin and soft tissue infections may present with cellulitis, skin abscess, and other syndromes of infection. […] Clinical manifestations and diagnosis of skin abscesses, furuncles, and carbuncles are discussed separately. […] To optimize the likelihood of cure, we recommend that all patients with a fluctuant skin abscess undergo incision and drainage to evacuate pus and necrotic debris. […] During the incision and drainage procedure, we recommend that samples of pus be obtained and sent for Gram stain and culture. […] We suggest antibiotic treatment for all patients undergoing incision and drainage of a skin abscess. […] For patients with multiple antibiotic allergies or intolerances or who prefer to forego antibiotic therapy, it is reasonable to withhold antibiotic therapy if the patient is otherwise healthy and meets all of the following criteria: Single abscess, Size of abscess <2 cm in diameter, No or minimal surrounding cellulitis, No systemic signs of toxicity, No immunosuppression or other comorbidities, No prior clinical failure with incision and drainage alone, No indwelling medical device, No risk factors for infective endocarditis, No exposure to situations that could increase transmission to others.

• #2 Abscesses – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/biology-of-infectious-disease/abscesses

  Diagnosis of cutaneous and subcutaneous abscesses is by physical examination. […] Diagnosis of deep abscesses often requires imaging. Ultrasound is noninvasive and detects many soft-tissue abscesses; CT is accurate for most, although MRI is usually more sensitive. […] Cutaneous and subcutaneous abscesses are diagnosed clinically; deeper abscesses often require imaging.

• #2 Cellulitis: Treatments, Causes, Symptoms, and More

  https://www.healthline.com/health/cellulitis

  Your doctor will likely be able to diagnose cellulitis just by looking at your skin. A physical exam might reveal: swelling of the skin, redness and warmth of the affected area, swollen glands. […] Depending on the severity of your symptoms, your doctor may want to monitor the affected area for a few days to see if the discoloration and swelling have spread. Sometimes, your doctor may take blood or a wound sample to test for bacteria. […] Cellulitis requires medical intervention. A healthcare professional will recommend oral antibiotics, intravenous antibiotics (IV), or both depending on your symptoms. […] Cellulitis is a bacterial skin infection that requires antibiotics to clear, so its unlikely to go away on its own. If left untreated, cellulitis may lead to serious complications. […] Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant bacteria that can cause cellulitis. In the case of MRSA cellulitis, your doctor will choose antibiotics that the bacteria isnt resistant to.

• #2 Abscess Evaluation | Sonoguide

  https://www.acep.org/sonoguide/procedures/abscess-evaluation

  Abscess and cellulitis are two of the most common soft-tissue infections seen in patients treated in emergency departments. Although they sometimes occur together, they are different disease processes requiring different treatments. […] It can be difficult to differentiate cellulitis from abscess based only on history and physical examination findings. Both processes can generally be characterized by warmth, erythema, tenderness, swelling, and induration. […] Because of the difficulty in diagnosis, the emergency physician might decide on an inappropriate treatment, resulting in one of two possible errors. Incision and drainage might not be done in a patient with an abscess, or incision and drainage could be performed on a patient who has cellulitis but no abscess. Increased pain and poor patient outcome can result from either of these errors.

• #2 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion. […] Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases. […] Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses, and large furuncles.

• #2 Abscess, Skin/soft Tissue | 5-Minute Emergency Consult

  https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307731/0.1/Abscess_Skin_soft_Tissue

  A localized collection of pus surrounded and walled off by inflamed tissue. […] Abscess formation typically occurs due to a break in the skin, obstruction of sebaceous or sweats glands, or inflammation of hair follicles. The collection may be classified as bacterial or sterile: […] Bacterial: Most abscesses are bacterial with the microbiology reflective of the microflora of the involved body part: […] S. aureus is the most common causative organism. […] Community-acquired MRSA (CA-MRSA) common. […] History and physical exam. […] Gram stain unnecessary for simple abscesses in healthy patients. […] Wound cultures: Not indicated in simple abscesses. […] May help guide therapy if systemic treatment is planned. […] May be useful in confirming CA-MRSA in patients with recurrent abscesses.

• #2 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  Cultures of blood are recommended, and cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites. […] The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period. […] Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient, or if outpatient treatment is failing. […] The most important therapy for an SSI is to open the incision, evacuate the infected material, and continue dressing changes until the wound heals by secondary intention.

• #2 Abscess – Types, Symptoms, Causes & Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/abscess

  Skin abscesses are more common than the mouth and internal organ abscesses. If you develop one, you should see a doctor for a proper diagnosis and treatment to prevent the spread of infection. […] Physical examination can diagnose a skin abscess. A pus sample may be taken for testing to identify the type of bacteria and prescribe an appropriate treatment. […] Imaging tests such as ultrasound, CT scan, and MRI may be necessary to investigate internal abscesses.

• #2 Point-of-care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27770490/

  Traditionally, emergency department (ED) physicians rely on their clinical examination to differentiate between cellulitis and abscess when evaluating skin and soft tissue infections (SSTI). […] The objective was to describe the operating characteristics of point-of-care ultrasound (POCUS) compared to clinical examination in identifying abscesses in ED patients with SSTI. […] The POCUS HSROC revealed a sensitivity of 97% (95% CI = 94% to 98%), specificity of 83% (95% CI = 75% to 88%), LR+ of 5.5 (95% CI = 3.7 to 8.2), and LR- of 0.04 (95% CI = 0.02 to 0.08). […] Existing evidence indicates that POCUS is useful in identifying abscess in ED patients with SSTI. In cases where physical examination is equivocal, POCUS can assist physicians to distinguish abscess from cellulitis.

• #2 Subcutaneous abscess | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/subcutaneous-abscess?lang=us

  A subcutaneous abscess is a kind of soft tissue abscess and a manifestation of a spectrum of skin and soft tissue infections which also includes cellulitis and necrotizing fasciitis. It is a form of abscess which lies within the dermis and subdermal cutaneous layers. Along with dental abscesses, the subcutaneous layer is the most common site for abscess formation. […] Subcutaneous abscesses are usually diagnosed clinically and do not routinely require any imaging. In complex cases where possible radical surgical treatment is being considered imaging may be undertaken to determine the extent of soft tissue involvement. MRI is the preferred modality for the evaluation of more deep soft tissue abscesses. […] Ultrasound is being shown to be increasingly useful for differentiating cellulitis with gross cutaneous swelling from a true abscess, with one study reporting that ultrasound evaluation changed management in half of all emergency cases of cellulitis.

• #2 Accuracy of Point-of-Care Ultrasound for Diagnosing Soft Tissue Abscess – TheNNT

  https://www.thennt.com/cms/lr/accuracy-point-care-ultrasound-diagnosing-soft-tissue-abscess/

  Based on this evidence, the accuracy numbers reported in the systematic review do not appear reliably valid for typical or common POCUS use in SSTI. We believe that the diagnostic accuracy of POCUS is dependent on the pre-test probability of abscess. POCUS does appear, however, to be potentially helpful in identifying abscess in ED patients in cases of diagnostic uncertainty.

• #2

  https://www2.hse.ie/conditions/abscess/diagnosis/

  Talk to your GP if you think you have an abscess. […] There are a few tests used to diagnose an abscess. The type of test you get depends on where it is on your body. […] If you have a skin abscess, a GP will examine the affected area and may ask you: […] Some pus may be taken from your abscess and sent for testing. This will identify the type of bacteria causing the abscess. This helps to find the best way of treating it. […] If you’ve had more than 1 skin abscess, you may need to give a sample of your pee. This will be tested for glucose, which is a sign of diabetes. People with diabetes have an increased risk of developing skin abscesses. […] If you have recurring boils and abscesses, your GP may get the laboratory to do more tests on the bacteria. These extra tests will show if it’s producing Panton-Valentine leukocidin (PVL) toxin.

• #2 Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by IDSA

  https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/

  The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based upon presence or absence of systemic inflammatory response syndrome (SIRS). […] 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. […] Recurrent abscesses should be drained and cultured early in the course of infection. […] After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated. […] Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood. […] Cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended.

• #2 Abscess – Wikipedia

  https://en.wikipedia.org/wiki/Abscess

  An abscess is a localized collection of pus (purulent inflammatory tissue) caused by suppuration buried in a tissue, an organ, or a confined space, lined by the pyogenic membrane. Ultrasound imaging can help in a diagnosis. […] Diagnosis of a skin abscess is usually made based on what it looks like and is confirmed by cutting it open. Ultrasound imaging may be useful in cases in which the diagnosis is not clear. In abscesses around the anus, computer tomography (CT) may be important to look for deeper infection. […] Abscesses should be differentiated from empyemas, which are accumulations of pus in a preexisting, rather than a newly formed, anatomical cavity. Other conditions that can cause similar symptoms include: cellulitis, a sebaceous cyst, and necrotising fasciitis. Cellulitis typically also has an erythematous reaction, but does not confer any purulent drainage.

• #2 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment

  Several trials have indicated a benefit to antibiotic therapy, even in patients with small abscesses. […] The choice of antibiotic is typically dependent on the suspected microorganisms, severity of illness, and patient allergies and comorbidities. […] Patients with skin abscess should receive empiric therapy that covers S. aureus, including MRSA. […] The decision to initiate parenteral therapy is typically based on the extent and severity of infection and patient comorbidities. […] For individuals with skin abscess, we suggest initial treatment with parenteral antibiotics in the following circumstances: Systemic signs of toxicity, Rapid progression of erythema or abscess, Extensive abscess or surrounding erythema, Immunocompromising condition, Inability to tolerate or absorb oral therapy.

• #2 Skin abscesses in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/skin-abscesses-in-adults-treatment/print

  The duration of therapy should be individualized based on clinical response. […] Patients receiving outpatient therapy should have follow-up evaluation after treatment initiation to verify clinical response. […] Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse. […] Recurrences of skin abscesses are not uncommon, occurring in 7 to 14 percent of individuals within two months of completing therapy. […] The mainstay of prevention includes attention to personal hygiene, decolonization, and consideration of the possibility of household or interpersonal transmission. […] For patients with recurrent MRSA infection despite hygiene optimization or with ongoing transmission among close contacts, we suggest S. aureus decolonization.

• #2 Abscess Evaluation | Sonoguide

  https://www.acep.org/sonoguide/procedures/abscess-evaluation

  Many researchers, including emergency physicians, have reported on the utility of ultrasound in the evaluation of abscesses and cellulitis. […] One group of emergency physicians found that soft-tissue ultrasound changed the management strategy for approximately half of their patients and concluded that ultrasound was useful because it could detect occult abscesses and avoid invasive procedures. […] The use of point-of-care ultrasound has been associated with a decreased length of stay for children with soft tissue infection. […] Ultrasound also allows many procedures to be done with greater safety. In the case of abscess drainage, ultrasound can locate adjacent structures such as large blood vessels and nerves that need to be avoided during the drainage procedure. […] The use of bedside ultrasound can also help determine the treatment of a specific abscess based on its size and depth. If an abscess is very small (1 cm diameter), the physician might choose treatment with antibiotics and warm compresses rather than incision and drainage.

• #3 Hidradenitis suppurativa – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/diagnosis-treatment/drc-20352311

  Hidradenitis suppurativa can be mistaken for pimples or acne. For many people, it takes years to receive a correct diagnosis. […] Your health care provider will base a diagnosis on your signs and symptoms, skin appearance, and medical history. You might be referred to a health care provider who specializes in skin conditions, also known as a dermatologist. Hidradenitis suppurativa can be difficult to diagnose and requires specialized care. […] No laboratory test is available to diagnose hidradenitis suppurativa. But if pus or drainage is present, your health care provider might take a sample for lab testing.

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