ABSTRACT
STUDY OBJECTIVE: To determine the prevalence of bacteremia associated with incision and drainage (I&D) of cutaneous abscesses in afebrile adult emergency department patients. Such information has implications for the ED management of immunocompromised patients, patients with history of endocarditis, and patients with prosthetic appliances such as heart valves and artificial joints. METHODS: We conducted a prospective clinical study in the adult ED of an urban tertiary care teaching hospital. Our subjects were afebrile patients aged 18 to 65 years with localized, nondraining, purulent cutaneous abscesses requiring outpatient surgical management. Before I&D, blood for aerobic and anaerobic blood culture was drawn under sterile conditions. The wound was opened and samples for aerobic wound culture were obtained. Two and 10 minutes after I&D, blood was again drawn, from separate venipunctures. All patients were discharged home with ED follow-up scheduled 48 hours later. RESULTS: From the 50 patients who completed the study, 150 blood samples (50 before and 100 after I&D) and 50 wound samples were obtained. No blood culture was positive, but 30 wound cultures (64%) were positive; the most commonly isolated organism was Staphylococcus aureus. CONCLUSION: I&D of localized cutaneous abscesses in afebrile adults is unlikely to result in transient bacteremia. Larger studies are needed to determine whether routine antibiotic prophylaxis is necessary for afebrile patients undergoing I&D.
Subject(s)
Abscess/surgery , Bacteremia/complications , Skin Diseases/surgery , Staphylococcal Infections/microbiology , Staphylococcus aureus , Abscess/complications , Abscess/microbiology , Adolescent , Adult , Aged , Blood/microbiology , Drainage , Female , Humans , Male , Middle Aged , Prospective Studies , Skin Diseases/microbiologyABSTRACT
We report an unintentional thiopental-facilitated interview in a patient presenting with apparent respiratory failure as a manifestation of Munchausen's syndrome. Unnecessary intubation was avoided and correct diagnosis was made using the thiopental interview. Patients with suspected Munchausen's syndrome represent a difficult dilemma for the emergency physician. Use of the barbiturate-facilitated interview in the emergency department may reveal the diagnosis and prevent unnecessary procedures and hospitalization.
