The Limited Role of Microbiological Culture and Sensitivity in the Management of Superficial Soft Tissue Abscesses

Abstract

The aim of this study was to assess the role of the routine practice of microbial culture and sensitivity at incision and drainage of superficial soft tissue abscesses. The case notes of 162 consecutive patients, selected from the microbiology database over a period of 1 year, were reviewed. All had incision and drainage of superficial soft tissue abscesses and included perianal, pilonidal, axillary, and breast abscesses. Patients with chronic wounds, recurrent abscesses, diabetes, pregnancy, and immunosuppression were excluded. The impact of pus culture and sensitivity (C/S) on management and clinical outcome was documented. Out of 162 patients, 97 were male (59.8%) and 65 were female (40.1%). Only 115 (70.9%) yielded positive cultures and 47 (29.1%) were sterile. The cultured microbial flora was predictable and sensitive to empirical antibiotics. In four patients, the results of microbial culture sensitivity showed microbial resistance to empirical antibiotics; however, it did not affect the management or the outcome for these patients. The routine practice of sending swabs for C/S after incision and drainage of superficial soft tissue abscesses does not contribute significantly towards patient management. Most patients are already on antibiotics prior to the referral and in the remainder, surgeons start antibiotics empirically. These broad-spectrum antibiotics cover the common pathogens involved, and there is no significant change in the antibiotic treatment after reviewing the culture reports following incision and drainage of uncomplicated superficial skin abscesses.

Microbiology of the infected recurrent sacrococcygeal pilonidal sinus

“…In this study, the frequency of bacterial growth in swab samples was comparable in patients with pPS (84·93%) and rPS (86·96%), which is in accordance with the findings of Khan et al (80·00%) . Many studies have reported a predominance of anaerobic bacteria in aspirates and swab samples from patients with pPS, reported genera including Bacteroides , Clostridium , Fusobacteria and Prevotella Our findings confirm the predominance of anaerobic bacteria in pPS.…”

The Role of Wound Swab Microbial Cultures and Antibiotic Sensitivity Results in the Management of Sacrococcygeal Pilonidal Abscess

“…In this current study, of the 75.4% of patients that had wound swabs taken, 87. [4]. The most common microorganisms identified in culture in this current study was mixed anaerobic microorganisms (61.6%), a finding similar to other studies [3,4].…”

“…One retrospective study on all cutaneous abscesses reported that 67.5% of their patients had wound specimens sent to the laboratory from the procedure [5]. Another study reported that 100% of their patients had wound swabs taken at the procedure which was assumed from a microbiology database [4]. In this current study, of the 75.4% of patients that had wound swabs taken, 87.…”

Does pilonidal abscess heal quicker with off-midline incision and drainage?

“…Forty patients (17.9%) underwent additional surgery. Out of these 40 patients, 28 underwent elective pilonidal sinus surgery following single (23) or recurrent (5) abscess drainage, 10 drainage for recurrent abscess(es) without sinus surgery, and 2 abscess drainage some time after elective sinus surgery. In this general group, additional surgery was not related to gender (P = 0.68) or the site of initial drainage (P = 0.74).…”

“…spreading cellulitis, immunocompromised patient), the choice of agent is made prior to knowing the culture results. Studies of other subcutaneous abscesses suggest that knowledge of the usual pathogens guides the clinician to an appropriate antibiotic choice and that antibiotic treatment is rarely changed after reviewing the culture result (even where resistant pathogens are found) [23][24][25]. In those situations where antibiotics are prescribed for patients with a pilonidal abscess, anaerobic cover is essential, but in our patients, this was often omitted.…”