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Soru

Zorluk: OrtaInfectious Diseases

A 19-year-old man comes to the university health clinic due to a painful swelling in his right axilla that has been worsening over the past 4 days. He is a collegiate wrestler and reports that several of his teammates have recently been treated for similar skin lesions. He has no significant past medical history and takes no medications. Vital signs are temperature 37.0°C (98.6°F), blood pressure 118/76 mm Hg, pulse 74/min, and respirations 14/min. Physical examination shows a 3.5-cm, exquisitely tender, erythematous, and fluctuant nodule in the right axilla. There is no surrounding induration or erythema extending beyond the nodule, and no regional lymphadenopathy is appreciated. Which of the following is the most appropriate next step in management?

  1. Incision and drainage of the lesionCevap
  2. B
    Incision and drainage followed by oral trimethoprim-sulfamethoxazole
  3. C
    Oral cephalexin therapy
  4. D
    Intravenous vancomycin therapy
  5. E
    Swab of the overlying skin for bacterial culture

Cevap

Incision and drainage of the lesion
The patient presents with a mild, purulent skin and soft tissue infection (cutaneous abscess). In healthy, immunocompetent patients who do not exhibit signs of systemic inflammatory response (such as fever, tachycardia, or tachypnea) and who lack extensive surrounding cellulitis, the definitive treatment is incision and drainage alone. Systemic antibiotics are not routinely indicated for simple abscesses following adequate source control, as they do not significantly improve cure rates and contribute to unnecessary antibiotic exposure.

Adım Adım Çözüm

1
Evaluate the clinical presentation and physical examination findings.
The patient has a 3.5-cm, exquisitely tender, erythematous, fluctuant nodule without systemic signs (such as fever or tachycardia) or extensive surrounding cellulitis.
Determining the severity of a skin and soft tissue infection (SSTI) dictates the need for surgical versus medical intervention.
2
Classify the infection according to clinical guidelines.
This is classified as a mild, purulent skin and soft tissue infection (simple abscess).
Guidelines stratify purulent SSTIs into mild (no systemic signs), moderate (systemic signs present), and severe (failed previous treatment, deep infection, or immunocompromise).
3
Determine the most appropriate next step in management based on the classification.
The primary and definitive treatment for a mild, uncomplicated abscess is incision and drainage alone.
Source control is curative for simple abscesses. Adding systemic antibiotics does not significantly improve outcomes in healthy individuals and violates antimicrobial stewardship.

Anahtar Kavram

The standard of care for a mild, uncomplicated cutaneous abscess in an immunocompetent patient without systemic signs of illness is incision and drainage alone; adjunctive systemic antibiotics are not indicated.
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