Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus
N Engl J Med March 13, 2014 V.370 P.1039-1047
Adam J. Singer, M.D., and David A. Talan, M.D.
From the Department of Emergency Medicine, Stony Brook University, Stony Brook, NY (A.J.S.); the Departments of Emergency Medicine and Medicine, Division of Infectious Diseases, Olive View–UCLA Medical Center, Sylmar, CA (D.A.T.); and the David Geffen School of Medicine at UCLA, Los Angeles (D.A.T.).
Address reprint requests to Dr. Singer at the Department of Emergency Medicine, Stony Brook University, HSC-L4-080, Stony Brook, NY 11794-8350, or at firstname.lastname@example.org
Abscesses are one of the most common skin conditions managed by general practitioners and emergency physicians.
The incidence of skin abscesses has increased, and this increase has coincided with the emergence of community-associated methicillin-resistant Staphylococcus aureus (MRSA).
In many parts of the world, MRSA infections are now the most common cause of skin abscesses.6 Community-associated MRSA has also been found to cause severe infections — including necrotizing pneumonia, necrotizing fasciitis, purpura fulminans, and severe sepsis — in nonimmunocompromised hosts; however, its apparently increased virulence as compared with that of health care–associated strains and methicillin-susceptible S. aureus is incompletely understood.
Along with the increases in the incidence of skin abscesses and MRSA infections, other changes that potentially affect abscess care have occurred. Bedside ultrasonography has become increasingly available in emergency departments and hospitals. Traditional surgical practices have been systematically tested, and new techniques developed.
Prevention strategies have also been investigated. Despite these changes, the management of skin abscesses is highly variable……