INCISION AND DRAINAGE OF CUTANEOUS ABSCESSES IS NOT ASSOCIATED WITH BACTEREMIA IN AFEBRILE ADULTS

Study objective: To determine the prevalence of bacteremia associated with incision and drainage (I&D) of cutaneous abscesses in afebrile ad ult emergency department patients. Such information has implications f or the ED management of immunocompromised patients, patients with hist ory of endocarditis, and patients with prosthetic appliances such as h eart valves and artificial joints. Methods: We conducted a prospective clinical study in the adult ED of an urban tertiary care teaching hos pital. Our subjects were afebrile patients aged 18 to 65 years with lo calized, nondraining, purulent cutaneous abscesses requiring outpatien t surgical management. Before I&D, blood for aerobic and anaerobic blo od culture was drawn under sterile conditions. The wound was opened an d samples for aerobic wound culture were obtained. Two and 10 minutes after I&D, blood was again drawn, from separate venipunctures. All pat ients were discharged home with ED follow-up scheduled 48 hours later. Results: From the 50 patients who completed the study, 150 blood samp les (50 before and 100 after I&D) and 50 wound samples were obtained. No blood culture was positive, but 30 wound cultures (64%) were positi ve; the most commonly isolated organism was Staphylococcus aureus. Con clusion: I&D of localized cutaneous abscesses in afebrile adults is un likely to result in transient bacteremia. Larger studies are needed to determine whether routine antibiotic prophylaxis is necessary for afe brile patients undergoing I&D.