From the Guidelines
Treatment for an infected hematoma should always begin with prompt surgical drainage of the infected collection, followed by antibiotic therapy and supportive care, as this approach has been shown to be effective in eliminating the infection and promoting healing 1. The first step in treating an infected hematoma is surgical drainage, which can be performed using a needle aspiration or surgical incision, depending on the size and location of the hematoma. This procedure removes the accumulated blood and pus that serve as a medium for bacterial growth. Following drainage, antibiotic therapy is essential to eliminate the infection. The selected antimicrobial agent should have activity against the identified or presumptive causative pathogen(s), known distribution to the site of infection, and proven therapeutic efficacy in the infection being treated 1. Common antibiotics prescribed for infected hematomas include cephalexin, clindamycin, or trimethoprim-sulfamethoxazole, though the specific antibiotic depends on the causative organism and local resistance patterns. Supportive care, such as warm compresses applied to the area for 15-20 minutes several times daily, can help improve blood circulation and promote healing. Pain management with acetaminophen or ibuprofen may be necessary. It's also important to keep the area clean and dry, changing any dressings as instructed by the healthcare provider. Infected hematomas require prompt treatment because the infection can spread to surrounding tissues or enter the bloodstream, potentially causing sepsis. If symptoms worsen despite treatment, including increased pain, redness, swelling, fever, or if red streaks appear extending from the site, immediate medical attention is necessary. In general, the management of infected hematomas should be guided by the principles of adequate source control, appropriate antibiotic therapy, and supportive care, as outlined in the 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy 1. The use of antibiotics should be tailored to the specific needs of the patient, taking into account factors such as comorbidities, concomitant therapies, and organ function 1. Overall, the goal of treatment for an infected hematoma is to eliminate the infection, promote healing, and prevent complications, such as sepsis or abscess formation. By following a comprehensive approach that includes prompt surgical drainage, appropriate antibiotic therapy, and supportive care, healthcare providers can help improve outcomes for patients with infected hematomas. It is also worth noting that, according to the 2018 WSES/SIS-E consensus conference, surgical debridement is necessary to remove necrotic tissue, and antibiotic therapy should be used for patients with severe infections, including those with spreading cellulitis or patients with systemic signs of infection 1.
From the Research
Treatment Options for Infected Hematoma
- Surgical drainage is a common treatment approach for infected hematomas, as seen in cases of subdural hematoma 2 and spontaneous sublingual haematoma 3.
- Percutaneous drainage is also an option, particularly for infected intraabdominal hematomas 4 and muscle hematomas in haemophiliacs 5.
- Laparoscopic drainage can be used for intramural duodenal hematoma 6.
Considerations for Treatment
- The choice of treatment depends on the location and severity of the infected hematoma.
- Craniotomy is recommended for infected subdural hematoma in adults 2.
- Percutaneous drainage may require close monitoring and longer drainage times compared to other types of abscesses 4.
- Ultrasound-guided percutaneous drainage or surgical drainage may be beneficial for muscle hematomas in non-haemophiliac patients 5.
Outcomes and Complications
- Successful treatment of infected hematomas can lead to complete resolution of symptoms and prevention of complications such as nerve injury, compartment syndrome, and infection 2, 4, 3, 6, 5.
- Untreated muscle bleeds can cause complications such as nerve injury, compartment syndrome, myositis ossificans, pseudotumour, and infection (abscess) 5.