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Incision, drainage optimal treatment method for MRSA-related skin abscesses
Gaspari RJ. Ann Emerg Med. 2011;doi:10.1016/j.annemergmed.2010.11.021.
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The standard practice of incision and drainage should remain the primary treatment for skin and soft tissue infections and not ultrasonographically guided needle aspiration, according to Romolo Gaspari, PhD, and colleagues.
The overall success rate for incision and drainage was 80% vs. 26% with ultrasonographically guided needle aspiration.
“With increasing levels of methicillin-resistant Staphylococcus aureus in the community, we will begin seeing higher failure rates for a condition that historically was easily treated,” Gaspari, of the department of emergency medicine at the University of Massachusetts, told Infectious Disease News.
Background data in the study suggest that some clinicians prefer ultrasonographically guided needle aspiration because it is less invasive than standard practice treatment. To determine whether ultrasonographically guided needle aspiration is comparable to incision and drainage in treating skin abscesses, the researchers conducted a nonrandomized, prospective, controlled trial that included 101 patients aged 18 years and older with uncomplicated superficial abscesses.
Patients were randomly assigned to incision and drainage (n=54) or ultrasonographically guided needle aspiration (n=47). Bedside ultrasonography was performed before and after the intervention. Patients were followed up in person by a clinician at 48 hours and via telephone on day 7.
Compared with a 26% success rate with ultrasonographically guided needle aspiration (95% CI, 18-44), researchers observed an 80% success rate with incision and drainage (95% CI, 66-89). However, patients with community-associated MRSA (n=33) were less likely to receive successful drainage with needle aspiration (8% vs. 55%) or incision and drainage (61% vs. 89%).
“The practice of using needle aspiration to determine if [incision and drainage] is warranted should be abandoned,” Gaspari said. “In our study, despite ultrasound guidance, we were unable to aspirate the abscess contents in many of the abscesses. Even though it is more painful, we found instead that incision and drainage was required. Neither method was especially effective for treating MRSA-positive abscesses, but the failure rate for needle aspiration was unacceptably high, despite ultrasound guidance.” – by Ashley DeNyse
Disclosure: Dr. Gaspari reported no relevant financial disclosures.
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