N Eray, H Bahar, M Torun, S Celayir
childhood, cutaneous abscess, outpatient
N Eray, H Bahar, M Torun, S Celayir. Pediatric Surgical Approach To Childhood Abscess: A Study From An Outpatient Facility. The Internet Journal of Microbiology. 2005 Volume 2 Number 1.
Percutaneous abscess drainage is a frequent procedure in the pediatric surgery outpatient setting (1,2). As seen as a simple procedures, the treatment and follow-up protocols are not standardized and overlooked. Additionally the organisms responsible for abscesses can differ in each institution (3,4). The aim of the study is to document the patients with abscess who had been treated surgically in our pediatric surgery outpatient setting.
Material And Methods
Within 2.5 year period, we investigated the total admissions, patients with abscess, their register cards, age distribution, abscess localization, complications, bacterial growth in the abscess materials, anaerobic and aerobic bacteria and susceptibility of bacteria retrospectively.
Between January 1999-April 2001, total outpatient admission was 6127 patients. Among this admission patients with abscess consists of 58 (0.94%) patients. Mean age was 3.5 years (11days-15years). Age distribution: Neonate (n=6), 1 month-1 year (n=19) and >1 year (n=33). The frequent localization of abscess was perianal and the frequent growing microorganisms were
Local (n=56) and general (n=2) anesthesia were used for abscess drainage. Following incision and drainage empirical antibiotics were initiated and changed if necessary according to the bacterial growth (BG). Average dressing was 1.3 days and varied with size and location. No major complication was observed in the follow-up. BG demonstrated on bacterial cultur of 45 of 58 admission (77%). Specimens from abscesses were cultured for aerobic and anaerobic microorganisms. These bacterial groups were presented in Table 2.
The predominant microorganisms were
Specimens from superficial abscesses in our outpatients were cultured and antibiotic susceptibility was obtained.
Superficial abscesses are commonly seen in the pediatric surgery outpatient setting. Treatment consists of surgical drainage with the addition of antibiotics. Incision is generally performed using local anesthesia (Chlorethan, Ethylcloride). Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes drains, analgesia and close follow-up and complications of this procedure include damage to adjacent structures, bacteremic complications and spread of infection owing to inadequate drainage (5).
Controversy exists about the value of antibiotic therapy following incision and drainage of cutaneous abscess. In their clinical trial, Llera JL et al concluded that antibiotics didn't alter the outcome of cutaneous abscess (2). It has been adviced that routine culture and antibiotic therapy were not indicated for localized abscesses in patients with normal host defenses (4). In this two clinical trials, postoperative antibiotic treatment was not recommended because the problems healed without complication. On contrary some investigators advocate that parenteral antibiotic treatment diminished the rate of bacteremia, when used before draining cutaneous abscess. Blood and pus specimen for bacteriological cultures were obtained at the same time in this study (6). Incision and drainage of localized abscesses in afebril adults was unlikely to result in transient bacteremia. Larger studies were needed to determine whether routine antibiotic prophilaxis was necessary for afebril patients undergoing incision and drainage (7). In our pediatric surgery outpatient setting, after draining and sampling for bacteriological cultures, we have been using empirical antibiotics. We haven't been seen major complication and clinical improvement was achived immediately.
Anatomic locations of cutaneous abscesses are different and in a study, forty-one percent of all abscesses were in the anogenital region (1). In our study, most frequent location was also the perianal region (31%). Mixed aerobic and anaerobic bacteria and mixed aerobic bacteria were frequent. This growing patttern was different from other studies where aerobic BG gave highest and mixed BG lowest percentages (1,8). Anaerobic microorganisms was frequently obtained from mixed bacterial cultures (6). In our study, anaerobic bacterial growth showed lowest percentage.
As seen in Table 3 & 4, frequent aerobic microorganisms were
We think that the initial empirical antibiotic should be sefaperazone-sulbactam in perianal abscess (
Intravenous diazepam can be used in outpatient procedures (9). But, we preferred only using local anesthesia in our outpatients with cutaneous abscesses.
Our approach to childhood abscess: When patients with cutaneous abscess admit to our pediatric surgery outpatient setting, specimen for bacteriological cultures is obtained, and then surgical drainage is performed using local anesthesia; empirical antibiotics are used and changed if necessary according to BG. Postoperative care which includes drains, analgesia, effective dresssings is very important. We are using this standart treatment protocol with success and no major complication was observed.
The frequent localizations of abscesses were perianal, submandibular and axillar.
Local anesthesia is preferred for abscess incision and drainage.
No differences have observed between different age groups on localization and complication of abscesses. 4. At last stage, aerobic and anaerobic culture should be done to find out antibiotic susceptibility.
The authors thank to the outpatient nurse Emine Tüysüz for her kind support during the study.
The standart treatment protocol for cutaneous abscess in childhood should include:
obtaining specimen for bacteriological cultures
postoperative analgesia and
effective dresssings for a successfull treatment.