From the Guidelines
If you develop an abscess after a steroid injection, seek immediate medical attention as this is a serious complication requiring prompt treatment, typically with incision and drainage of the abscess followed by antibiotics. The management of an abscess after a steroid injection prioritizes reducing morbidity, mortality, and improving quality of life. According to the most recent and highest quality study available, 1, the use of corticosteroids, such as dexamethasone, in patients with brain abscess and perifocal edema, may lead to decreased or weakened collagen deposition, potentially impairing capsule formation and increasing the risk of abscess rupture, although this was not confirmed in animal studies.
Key Considerations
- The introduction of bacteria during the injection procedure or compromised immune response in the area due to the steroid's immunosuppressive effects can lead to abscess formation.
- Prompt treatment with incision and drainage of the abscess, followed by antibiotics, is crucial to prevent further complications.
- Common antibiotic regimens may include clindamycin or a combination of amoxicillin-clavulanate, with the specific antibiotic choice based on culture results.
- Discontinuation of further steroid injections at the site until the infection resolves completely is typically recommended.
Prevention Strategies
- Ensuring injections are performed under strict sterile conditions by qualified healthcare professionals is vital to prevent infections.
- Watching for warning signs of infection, including increasing pain, redness, warmth, swelling, fever, or drainage from the injection site, and reporting these symptoms promptly, is essential for early intervention.
Evidence-Based Recommendations
The European Society of Clinical Microbiology and Infectious Diseases guidelines, 1, highlight the importance of symptom relief with adjunctive corticosteroids, if considered safe, but also note the potential risks associated with their use. Another study, 1, recommends prophylactic antibiotics before EUS-CPB when steroids are used, to cover enteric gram-negative organisms and enterococci. However, the primary focus should always be on preventing infections through proper technique and monitoring for signs of infection.
From the Research
Abscess Formation After Steroid Injection
- Abscesses can form after steroid injections due to various reasons, including non-sterile injection techniques and sharing of equipment 2, 3.
- Cases of abscess formation have been reported in individuals who inject anabolic-androgenic steroids intramuscularly, with infections caused by bacteria such as Staphylococcus, Streptococcus, and Pseudomonas 4, 2.
- The risk of infection is higher when individuals share needles or use non-sterile equipment, highlighting the need for education and prevention techniques to avoid such complications 2, 3.
- Abscesses can also occur after corticosteroid injections, as reported in cases of spinal epidural abscess and sterile abscess formation following injections for plantar fasciitis 5, 6.
- In some cases, abscesses may resolve with conservative medical management, while others may require surgical drainage 4, 5, 6.